Analysis of Early Post-Radiation Surgical Management of Metastatic Spinal Tumors

Background/Objectives: Radiotherapy is one of the various treatment options for patients with metastatic spinal tumors (MST). However, it is difficult to say that this is definitely an optimal treatment for MST, and there are several patients who need surgical treatment because pain or neurologic deficits occur even after radiotherapy. Therefore, this study aimed to analyze which patients received early operative treatment after radiotherapy. Methods: We included 81 patients who underwent decompression and fusion surgery after radiotherapy for MST. Patients who underwent surgery within 6 months after radiotherapy were classified as the early operation group (group E, n = 47), while surgery cases after 6 months after radiotherapy were assigned to the late operation group (group L, n = 34). Risk factor analysis using multivariate regression analysis for early operative treatment after radiotherapy was performed. Also, we analyzed the period from radiotherapy to surgery according to the Bilsky grade. Results: In multivariate analysis, pathologic fractures and semirigid (thoracic) lesions were more frequent in group E than group L (adjusted odds ratio, 4.282, 10.524; p = 0.001, 0.039). In subgroup analysis, there was a difference in the period from radiotherapy to surgery in Bilsky grades above 2 than Bilsky grade 1 (grade 1, 13.6 ± 11.4 months, grade 2, 6.9 ± 6.8 months, grade 3, 6.6 ± 7.5 months; grade 1 vs. 2, p = 0.049, grade 1 vs. 3, p = 0.047). Conclusions: Although the information in this study may only be limited to patients who underwent surgery, early operative treatment after radiotherapy is highly likely for patients with MST accompanied by a Bilsky grade above 2, pathologic fracture and thoracic lesion. In these patients, surgical treatment could be considered as the primary treatment.