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. 2022 Jun;19(2):434-440.
doi: 10.14245/ns.2244034.017. Epub 2022 May 15.

Impact of Radiation Therapy on Outcomes After Spinal Instrumentation for Craniocervical Junction Malignancies

Matthew Muir  1 , Laurence Rhines  1 , Franco Demonte  1 , Claudio Tatsui  1 , Shaan M Raza  1
Affiliations

Impact of Radiation Therapy on Outcomes After Spinal Instrumentation for Craniocervical Junction Malignancies

Matthew Muir et al. Neurospine. 2022 Jun.

Abstract

Objective: Spinal reconstruction after resection of invasive craniocervical junction malignancies is fraught with technical and management considerations as well as a paucity of data in the existing literature. In this study, we describe our experience with craniocervical junction malignancies, especially the influence of radiation on the need for revision spinal instrumentation.

Methods: We performed a retrospective chart review of all patients who underwent occipitocervical fixation between 2011 and 2019 at The University of Texas MD Anderson Cancer Center.

Results: Twenty-five patients had primary malignancies and 12 (30%) had metastatic tumors. Thirteen (33%) underwent a staged resection in multiple operations during their hospital stay. Tumor resection was performed in 19 patients (48%), while only stabilization was performed in 21 patients (52%). Nine patients (23%) underwent expanded endoscopic transclival approaches for tumor resection, 10 patients (25%) an extreme lateral approach, and 2 patients (5%) an anterior open approach. Eleven patients underwent early postoperative radiation therapy (within 3 months) and 8 underwent delayed radiation therapy (between 3 months and 1 year in 7 patients). The revision rate was 8%, with a median time to revision surgery of 42 months. The administration and timing of adjuvant radiation therapy relative to surgery had no significant effect on the need for instrumentation revision on log-rank and Cox regression analyses (p < 0.05).

Conclusion: Revision surgery was needed infrequently in our patients. Postoperative radiation therapy was not associated with hardware failure, indicating that the timing of radiation therapy should be dictated by the diagnosis and can be initiated postoperatively without delay.

Keywords: Cancer; Craniocervical junction; Instrumentation; Radiation.

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Conflict of interest statement

Conflict of Interest

The authors have nothing to disclose.

Figures

Fig. 1.
Fig. 1.
Kaplan-Meier curve of overall need for revision surgery in patients undergoing occipitocervical fixation for malignant disease.
Fig. 2.
Fig. 2.
Kaplan-Meier curve demonstrating impact of adjuvant radiation therapy on the need for revision surgery after occipitocervical fixation.
Fig. 3.
Fig. 3.
Kaplan-Meier curve demonstrating impact of adjuvant radiation therapy timing on the need for revision surgery after occipitocervical fixation.
See this image and copyright information in PMC

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