Postoperative Epidural Disease and Local Control After Separation Surgery and Spine Stereotactic Body Radiation...

Area of Science:

• Oncology
• Radiation Oncology
• Neurosurgery

Background:

• Spinal metastases are common and can cause significant morbidity.
• Limited data exist on the efficacy and safety of separation surgery combined with postoperative stereotactic body radiation therapy (SBRT).

Purpose of the Study:

• To evaluate the outcomes of patients with spinal metastases treated with separation surgery followed by SBRT.
• To assess local failure (LF) and adverse events, including hardware failure (HF), radiation myelitis (RM), and vertebral compression fracture (VCF).

Main Methods:

• Retrospective cohort study of 497 patients with 532 spinal lesions treated between 2013-2024.
• Analysis of LF and adverse events (HF, RM, VCF) with competing risks for death.
• Evaluation of dosimetric variables (CTV Dmin BED10) and epidural spinal cord compression (ESCC) scores.

Main Results:

• Median overall survival was 14 months; 3-year risk of LF was 13%.
• 2-year cumulative incidences for VCF, RM, and HF were 2%, 1%, and 3.8%, respectively.
• Higher CTV Dmin BED10 correlated with reduced LF risk; postoperative ESCC ≤1C predicted higher likelihood of achieving optimal CTV Dmin BED10.

Conclusions:

• Separation surgery with spine SBRT provides excellent local control and a low adverse event profile for spinal metastases.
• Higher CTV minimum biological dose, facilitated by postoperative ESCC ≤1C, is the strongest predictor of sustained local control.