Does surgery plus SBRT increase ALP risk patients with spine metastases?

Separation surgery followed by conformal postoperative spine stereotactic body radiation therapy (S-SBRT) shows similar infield and adjacent level progression (ALP) when compared with SBRT alone in patients with spine metastases, reports a study.

A retrospective analysis was conducted on a prospectively maintained database of adult spine oncologic patients who underwent SBRT to the spine at University of Michigan, US, from 2010 to 2021. The authors then compared ALP in patients undergoing SBRT who had pretreatment surgery with those who did not.

A total of 417 patients, involving 498 treatment sites, were included in the analysis. Of these, 366 (73.5 percent) were treated with SBRT alone and 132 (26.5 percent) with surgery followed by S-SBRT.

Patients in the SBRT alone group were significantly older than those in the surgery plus SBRT group (63.2 vs 60.2 years; p=0.02). More patients with radiosensitive histologies received SBRT alone versus surgery plus SBRT (34 percent vs 11 percent; p<0.001).

Lesions in patients who underwent surgery plus S-SBRT had significantly more severe metastatic epidural spinal cord compression than in those who underwent SBRT alone (65 percent vs 8 percent; p<0.001). No significant between-group difference was observed in both infield progression (9.3 percent vs 7.6 percent; p=0.43) and ALP (21.3 percent vs 18.9 percent; p=0.37).

“Spine oncology patients treated with surgery followed by conformal postoperative S-SBRT had similar infield and ALP compared with patients receiving SBRT alone, suggesting that piecemeal separation surgery does not locally spread tumour cells, leading to an increased risk of ALP failure, and supporting the use of conformal postoperative S-SBRT,” the authors said.