Direct Decompressive Surgery Followed by Radiotherapy Versus Radiotherapy Alone for Metastatic Epidural Spinal Cord Compression A Meta-analysis

Study Design. A systemic review and meta-analysis. Objective. To compare the ambulatory status and survival for metastatic epidural spinal cord compression (MESCC) in patients treated with direct decompressive surgical resection (DDSR) followed by radiotherapy (RTx) with those in patients treated with RTx alone. Summary of Background Data. Surgical techniques have remarkably evolved from decompressive laminectomy without ventral tumor excision to DDSR, which has displayed favorable outcomes since the 2000s. RTx alone has also evolved and is regarded to have accomplished outcome comparable with that of the surgery. The optimal treatment of MESCC has not been clearly defined yet. Methods. We searched MEDLINE, EMBASE, and the Cochrane library in July 2013. Comparative studies enrolled patients with similar performance, primary cancer, age, and sex at the baseline state were included. Outcome measures included ambulatory status and overall survival rate. We did a fixed-effects meta-analysis of the ambulatory status and survival in patients with MESCC compared with DDSR + RTx and RTx alone. Results. Five studies were used to obtain data from 238 and 1137 patients treated with DDSR+RTx and RTx alone, respectively. The DDSR+RTx group displayed substantial improvement in ambulatory status after the treatment that was superior to the improvement in the RTx-alone group (relative risk [RR], 1.43; 95% confidence interval [CI], 1.14-1.78) in a fixed-effects model and significantly lower deterioration after treatment than the RTx group (RR, 0.35; 95% CI, 0.19-0.63). The DDSR+RTx group showed signifi cant improvement in the survival rate at 6 months post-treatment (RR, 1.21; 95% CI, 1.09-1.33). Similar findings were observed at 12 months posttreatment (RR, 1.32; 95% CI, 1.12-1.56). Conclusion. The meta-analysis indicates that DDSR+RTx may produce better clinical improvement of ambulation status and survival than RTx alone in the treatment of MESCC. Additional prospective studies are warranted to better address this question.