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. 2023 Nov 22;15(23):5518.
doi: 10.3390/cancers15235518.

Efficacy of Total En Bloc Spondylectomy versus Stereotactic Ablative Radiotherapy for Single Spinal Metastasis

Dong-Ho Kang  1 , Wooseok Lee  1 , Bong-Soon Chang  1 , Hyoungmin Kim  1 , Sam Yeol Chang  1 , Seong Hwa Hong  1 , Jin Ho Kim  2 , Hee Jung Son  3
Affiliations

Efficacy of Total En Bloc Spondylectomy versus Stereotactic Ablative Radiotherapy for Single Spinal Metastasis

Dong-Ho Kang et al. Cancers (Basel). .

Abstract

To compare total en bloc spondylectomy (TES) with stereotactic ablative radiotherapy (SABR) for single spinal metastasis, we undertook a single center retrospective study. We identified patients who had undergone TES or SABR for a single spinal metastasis between 2000 and 2019. Medical records and images were reviewed for patient and tumor characteristics, and oncologic outcomes. Patients who received TES were matched to those who received SABR to compare local control and survival. A total of 89 patients were identified, of whom 20 and 69 received TES and SABR, respectively. A total of 38 matched patients were analyzed (19 TES and 19 SABR). The median follow-up period was 54.4 (TES) and 26.1 months (SABR) for matched patients. Two-year progression-free survival (PFS) and overall survival (OS) rates were 66.7% and 72.2% in the TES and 38.9% and 50.7% in the SABR group, respectively. At the final follow-up of the matched cohorts, no significant differences were noted in OS (p = 0.554), PFS (p = 0.345) or local progression (p = 0.133). The rate of major complications was higher in the TES than in the SABR group (21.1% vs. 10.5%, p = 0.660). These findings suggest that SABR leads to fewer complications compared to TES, while TES exhibits better mid-term control of metastatic tumors.

Keywords: spinal metastasis; stereotactic ablative radiotherapy; total en bloc spondylectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A 32-year-old male underwent total en bloc spondylectomy for a solitary metastasis of adrenal cortical carcinoma at T11. The following images are provided: (a) preoperative MRI, (b) preoperative whole-body FDG-PET CT, (c) gross pathology, and (d) postoperative radiography.
Figure 2
Figure 2
A 48-year-old female underwent total en bloc spondylectomy for a solitary metastasis of breast cancer at L2. The following images are provided: (a) preoperative MRI, (b) preoperative whole-body FDG-PET CT, (c) gross pathology, and (d) postoperative radiography.
Figure 3
Figure 3
Survival curve for overall survival among matched patients. TES, total en-bloc spondylectomy; SABR, stereotactic ablative radiotherapy.
Figure 4
Figure 4
Survival curve for progression-free survival among matched patients.
Figure 5
Figure 5
Survival curve for local metastasis progression among matched patients.
Figure 6
Figure 6
Kaplan–Meier curve depicting the proportion of matched patients maintaining an ECOG performance status of 2 or lower.
See this image and copyright information in PMC

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