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, 10 (1), 21-29

Surgical or Radiation Therapy for the Treatment of Cervical Spine Metastases: Results From the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) Cohort


Surgical or Radiation Therapy for the Treatment of Cervical Spine Metastases: Results From the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) Cohort

Michael R Bond et al. Global Spine J.


Study design: Ambispective cohort study design.

Objectives: Cervical spine metastases have distinct clinical considerations. The aim of this study was to determine the impact of surgical intervention (± radiotherapy) or radiotherapy alone on health-related quality of life (HRQOL) outcomes in patients treated for cervical metastatic spine tumours.

Methods: Patients treated with surgery and/or radiotherapy for cervical spine metastases were identified from the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) international multicentre prospective observational study. Demographic, diagnostic, treatment, and HRQOL (numerical rating scale [NRS] pain, EQ-5D (3L), SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months postintervention.

Results: Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery ± radiation and 17 received radiation alone. Surgically treated patients had higher mean spinal instability neoplastic scores compared with the radiation-alone group (13.0 vs 8.0, P < .001) and higher NRS pain scores and lower HRQOL scores compared to the radiation alone group (P < .05). From baseline to 6 months posttreatment, surgically treated patients demonstrated statistically significant improvements in NRS pain, EQ-5D (5L), and SOSGOQ2.0 scores compared with nonsignificant improvements in the radiotherapy alone group.

Conclusions: Surgically treated cervical metastases patients presented with higher levels of instability, worse baseline pain and HRQOL scores compared with patients who underwent radiotherapy alone. Significant improvements in pain and HRQOL were noted for those patients who received surgical intervention. Limited or no improvements were found in those treated with radiotherapy alone.

Keywords: cervical metastases; radiotherapy; spine oncology; surgery.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Fisher reports personal fees from Medtronic, and Nuvasive, grants from OREF, and receieves fellowship support paid by Medtronic and AOSpine. Dr Sahgal reports advisor with Abbvie, past educational seminars with Elekta AB, Accuray Inc., Varian medical systems, and BrainLAB, with research grant support from Elekta AB, and Travel accommodations/expenses by Elekta, Varian, BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium. Dr Sciubba reports personal fees from Medtronic, Depuy-Synthes, Stryker, Nuvasive, K2M, Baxter, Misonix, outside the submitted work. Dr Versteeg reports personal fees from AOSpine International, outside the submitted work. All other authors have no disclosures to report.


Figure 1.
Figure 1.
A 75-year-old woman with metastatic breast carcinoma, presenting with neck pain and no neurological symptoms. She received palliative radiation treatment to the cervical spine. She received 1800 cGy in 4 fractions.
Figure 2.
Figure 2.
A 63-year-old man with metastatic bladder carcinoma. He presented with mechanical neck pain, bilateral leg paresthesias, and hyperreflexia. Imaging demonstrated destruction of the C3 vertebral body with significant focal kyphosis and posterior subluxation of C2 into C3. He underwent an anterior C3 and C4 vertebral body resection, decompression spinal cord, and osteotomy with anterior correction of kyphosis. Anterior cage C2-5 with cement and plate C2-5.

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