A Comparative Study on the Effects of Postoperative  125 I Brachytherapy and Irradiation After Surgical Decompression and Stabilization for Metastatic Spinal Cancers

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Abstract

Purpose

The study aims to investigate and compare the efficacy and safety of intraoperative ¹²⁵I implantation and postoperative irradiation after surgical decompression and stabilization in the treatment of patients with metastatic epidural spinal cord compression (MESCC).

Methods

The study retrospectively enrolled 122 MESCC patients treated with surgical decompression and pedicle stabilization combined with ¹²⁵I brachytherapy (the brachytherapy group) or postoperative radiotherapy (the irradiation group). Operation time, intraoperative blood loss, pain relief, postoperative ambulatory status, postoperative survival outcome, complications, and length of hospitalization were collected and compared between the two groups. Ten potential risk factors were analyzed for postoperative survival outcome.

Results

No significant difference was found in baseline characteristics between the two groups (P>0.05). Postoperative VAS score was significantly decreased, as compared with preoperative scores in both groups (P˂0.001). The VAS in the brachytherapy group was significantly lower than that in the irradiation group at postoperative 1 month, 3 months, and 6 months (P˂0.05). The postoperative ambulatory rates were 90.0% (54/60) in the brachytherapy group and 83.9% (52/62) in the irradiation group (P=0.32). The median overall survival time was similar between the two groups (7.43 months vs 7.27 months, P=0.37). Of all patients in the brachytherapy group, 25.0% (15/60) of patients suffered from complications, while 46.8% (29/62) of patients had complications in the irradiation group (P=0.0086). According to the multiple Cox regression, primary sites (P=0.038), ECOG performance status (P=0.014), and visceral metastases (P=0.0016) showed significance for postoperative survival outcome.

Conclusion

Surgical decompression and spine stabilization combined with ¹²⁵I brachytherapy is a relatively safe and useful method in MESCC patients.

Related collections

Most cited references 22

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Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.

Roy Patchell, Phillip A Tibbs, William F. Regine … (2005)

The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompressive surgery. In this randomised, multi-institutional, non-blinded trial, we randomly assigned patients with spinal cord compression caused by metastatic cancer to either surgery followed by radiotherapy (n=50) or radiotherapy alone (n=51). Radiotherapy for both treatment groups was given in ten 3 Gy fractions. The primary endpoint was the ability to walk. Secondary endpoints were urinary continence, muscle strength and functional status, the need for corticosteroids and opioid analgesics, and survival time. All analyses were by intention to treat. After an interim analysis the study was stopped because the criterion of a predetermined early stopping rule was met. Thus, 123 patients were assessed for eligibility before the study closed and 101 were randomised. Significantly more patients in the surgery group (42/50, 84%) than in the radiotherapy group (29/51, 57%) were able to walk after treatment (odds ratio 6.2 [95% CI 2.0-19.8] p=0.001). Patients treated with surgery also retained the ability to walk significantly longer than did those with radiotherapy alone (median 122 days vs 13 days, p=0.003). 32 patients entered the study unable to walk; significantly more patients in the surgery group regained the ability to walk than patients in the radiation group (10/16 [62%] vs 3/16 [19%], p=0.01). The need for corticosteroids and opioid analgesics was significantly reduced in the surgical group. Direct decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.

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Metastatic epidural spinal cord compression.

John S Cole, Roy A Patchell (2008)

Metastatic epidural spinal cord compression (MESCC) occurs when cancer metastasises to the spine or epidural space and causes secondary compression of the spinal cord. MESCC is a common complication of malignancy that affects almost 5% of patients with cancer. The most common symptom is back pain. MESCC is a medical emergency that needs rapid diagnosis and treatment if permanent paralysis is to be prevented: the diagnosis of MESCC is best made with MRI; and corticosteroids, radiation therapy, and surgery are all established treatments. Future research will focus on prevention, improving detection, and the development of new treatments.

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High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial.

Peter J Hoskin, Kate Motohashi, Peter Bownes … (2007)

A randomised phase III trial has compared external beam radiotherapy alone with a dose escalated schedule using high dose rate brachytherapy. Patients with histologically confirmed prostate cancer, no evidence of metastases, a PSA <50, no previous TURP and fit for general anaesthetic were included. Patients were randomised to receive either standard radiotherapy 55 Gy in 20 fractions treating Monday to Friday over 4 weeks or a combined schedule comprising external beam treatment delivering 35.75 Gy in 13 fractions treating daily Monday to Friday over 2.5 weeks followed by a temporary high dose rate afterloading implant delivering 17 Gy in two fractions over 24h. A total of 220 patients were randomised, balanced for important prognostic parameters including tumour stage, presenting PSA, Gleason score and use of adjuvant anti-androgens. With a median follow up of 30 months (range 3-91) a significant improvement in actuarial biochemical relapse-free survival is seen in favour of the combined brachytherapy schedule (p=0.03). A lower incidence of acute rectal discharge was seen in the brachytherapy group (p=0.025) and other acute and late toxicities were equivalent. Patients randomised to brachytherapy had a significantly better FACT-P score at 12 weeks (p=0.02). The use of high dose rate brachytherapy in combination with external beam radiotherapy resulted in an improved biochemical relapse-free survival compared to external beam radiotherapy alone with less acute rectal toxicity and improved quality of life in this randomised trial.

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Author and article information

Journal

Journal ID (nlm-ta): J Multidiscip Healthc

Journal ID (iso-abbrev): J Multidiscip Healthc

Journal ID (publisher-id): jmdh

Journal ID (pmc): jmulthealth

Title: Journal of Multidisciplinary Healthcare

Publisher: Dove

ISSN (Electronic): 1178-2390

Publication date (Electronic): 23 October 2020

Publication date Collection: 2020

Volume: 13

Pages: 1245-1256

Affiliations

[1 ]Department of Orthopedic Surgery, Peking University First Hospital , Beijing, People’s Republic of China

[2 ]Department of Orthopedic Surgery, The Fourth Medical Center of Chinese PLA General Hospital , Beijing, People’s Republic of China

[3 ]Department of Pulmonary Neoplasms Internal Medicine, The Fifth Medical Center of the Chinese PLA General Hospital , Beijing, People’s Republic of China

[4 ]Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital , Sanya, People’s Republic of China

Author notes

Correspondence: Yaosheng Liu Department of Orthopedic Surgery, The Fourth Medical Center of Chinese PLA General Hospital , No. 8, Fengtaidongda Road, Beijing100071, People’s Republic of ChinaTel/Fax +86-10-66947017 Email 632763246@qq.com

[*]

These authors contributed equally to this work

Author information

Haifeng Qin http://orcid.org/0000-0001-6645-7095

Article

Publisher ID: 279677

DOI: 10.2147/JMDH.S279677

PMC ID: 7591013

SO-VID: 9d9ded26-6150-4851-821f-101da8a6fd5f

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 31 August 2020

Date accepted : 06 October 2020

Page count

Figures: 5, Tables: 6, References: 22, Pages: 12

Funding

Funded by: the Medical and health science and technology innovation project of Sanya;

Funded by: Beijing Municipal Science and Technology Commission;

This study was supported by the Medical and health science and technology innovation project of Sanya (NO. 2018YW04) and Beijing Municipal Science and Technology Commission (NO. Z161100000516101 and NO.Z171100001017176).