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A meta-analysis of surgery versus
conventional radiotherapy for the treatment of metastatic spinal
epidural disease
Paul Klimo Jr., Clinton
J. Thompson, John R.W. Kestle, and Meic H. Schmidt
Departments of
Neurosurgery (P.K., J.R.W.K., M.H.S.) and Family & Preventive
Medicine (C.S.T.) and Spinal Oncology Service, Huntsman Cancer
Institute (M.H.S.), University of Utah, Salt Lake City, UT 84108, USA
. Address correspondence to Meic H. Schmidt, Department of
Neurosurgery, University of Utah, 30 North 1900 East, Suite #3B-409
SOM, Salt Lake City, UT 84132-2303, USA meic.schmidt@hsc.utah.edu).
Radiotherapy has been the primary
therapy for managing metastatic spinal disease; however, surgery that
decompresses the spinal cord circumferentially, followed by
reconstruction and immediate stabilization, has also proven
effective.
We provide a quantitative comparison
between the "new" surgery and radiotherapy, based on
articles that report on ambulatory status before and after treatment,
age, sex, primary neoplasm pathology, and spinal disease
distribution.
Ambulation was categorized as
"success" or "rescue" (proportion of patients
ambulatory after treatment and proportion regaining ambulatory
function, respectively).
Secondary outcomes were also
analyzed.
We calculated cumulative success and
rescue rates for our ambulatory measurements and quantified
heterogeneity using a mixed-effects model.
We investigated the source of the
heterogeneity in both a univariate and multivariate manner with a
meta-regression model.
Our analysis included data from 24
surgical articles (999 patients) and 4 radiation articles (543
patients), mostly uncontrolled cohort studies (Class III).
Surgical patients were 1.3 times more
likely to be ambulatory after treatment and twice as likely to regain
ambulatory function.
Overall ambulatory success rates for
surgery and radiation were 85% and 64%, respectively.
Primary pathology was the principal factor
determining survival.
We present the first known formal
meta-analysis using data from nonrandomized clinical studies.
Although we attempted to control for
imbalances between the surgical and radiation groups, significant
heterogeneity undoubtedly still exists.
Nonetheless, we believe the differences in
the outcomes indicate a true difference resulting from
treatment.
We conclude that surgery should usually be
the primary treatment with radiation given as adjuvant therapy.
Neurologic status, overall health, extent
of disease (spinal and extraspinal), and primary pathology all impact
proper treatment selection.
© 2005 Duke University Press
Source: http://hermia.ingentaselect.com/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v7n1/s7/p64&user_id=undefined
DOI: http://dx.doi.org/10.1215/S1152851704000262
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