Radiotherapy or surgery for spine metastases?

Acta Orthop. 2011 Jun;82(3):365-71. doi: 10.3109/17453674.2011.566142. Epub 2011 Mar 24.


Background and purpose: Radiotherapy (RT) remains the cornerstone of management of spine metastases (SM), even though surgery is a well-established treatment for selected patients. We compared the use of RT and surgery in a population-based cohort of patients with SM, investigated pre-treatment factors that were associated with use of these treatment modalities, and examined survival.

Patients and methods: 903 patients in the south-eastern Norway who were admitted for RT or surgery for SM for the first time during an 18-month period in 2007-2008 were identified and their medical records were reviewed.

Results: The primary treatment was surgery in 58 patients and RT in 845 patients, including 704 multiple-fraction (MF) and 141 single-fraction (SF) RT schedules. 11 of 607 patients without motor impairment (2%) and 47 of 274 patients with motor impairment (17%) underwent primary operations. 11 of 58 operated patients and 244 of 845 irradiated patients died within 2 months after the start of treatment. 26% of those who received multiple-fraction RT or surgery died within 2 months.

Interpretation: Motor impairment was the main indication for surgery. Better identification of patients with short survival is needed to avoid time-consuming treatment (major surgery and long-term RT).

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Motor Activity
  • Norway / epidemiology
  • Patient Selection
  • Retrospective Studies
  • Spinal Cord Compression / etiology
  • Spinal Cord Compression / therapy
  • Spinal Neoplasms* / mortality
  • Spinal Neoplasms* / radiotherapy
  • Spinal Neoplasms* / secondary
  • Spinal Neoplasms* / surgery
  • Survival Analysis
  • Treatment Outcome
  • Young Adult