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A Comparative Study on the Effects of Postoperative 125I Brachytherapy and Irradiation After Surgical Decompression and Stabilization for Metastatic Spinal Cancers

Authors Shi X, Liu Y, Cui Y, Qin H, Yang S, Lei M

Received 31 August 2020

Accepted for publication 6 October 2020

Published 23 October 2020 Volume 2020:13 Pages 1245—1256

DOI https://doi.org/10.2147/JMDH.S279677

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Xuedong Shi,1,* Yaosheng Liu,2,* Yunpeng Cui,1 Haifeng Qin,3 Shaoxing Yang,3 Mingxing Lei4

1Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Orthopedic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Department of Pulmonary Neoplasms Internal Medicine, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, People’s Republic of China; 4Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yaosheng Liu
Department of Orthopedic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, No. 8, Fengtaidongda Road, Beijing 100071, People’s Republic of China
Tel/Fax +86-10-66947017
Email 632763246@qq.com

Purpose: The study aims to investigate and compare the efficacy and safety of intraoperative 125I implantation and postoperative irradiation after surgical decompression and stabilization in the treatment of patients with metastatic epidural spinal cord compression (MESCC).
Methods: The study retrospectively enrolled 122 MESCC patients treated with surgical decompression and pedicle stabilization combined with 125I brachytherapy (the brachytherapy group) or postoperative radiotherapy (the irradiation group). Operation time, intraoperative blood loss, pain relief, postoperative ambulatory status, postoperative survival outcome, complications, and length of hospitalization were collected and compared between the two groups. Ten potential risk factors were analyzed for postoperative survival outcome.
Results: No significant difference was found in baseline characteristics between the two groups (P> 0.05). Postoperative VAS score was significantly decreased, as compared with preoperative scores in both groups (P˂0.001). The VAS in the brachytherapy group was significantly lower than that in the irradiation group at postoperative 1 month, 3 months, and 6 months (P˂0.05). The postoperative ambulatory rates were 90.0% (54/60) in the brachytherapy group and 83.9% (52/62) in the irradiation group (P=0.32). The median overall survival time was similar between the two groups (7.43 months vs 7.27 months, P=0.37). Of all patients in the brachytherapy group, 25.0% (15/60) of patients suffered from complications, while 46.8% (29/62) of patients had complications in the irradiation group (P=0.0086). According to the multiple Cox regression, primary sites (P=0.038), ECOG performance status (P=0.014), and visceral metastases (P=0.0016) showed significance for postoperative survival outcome.
Conclusion: Surgical decompression and spine stabilization combined with 125I brachytherapy is a relatively safe and useful method in MESCC patients.

Keywords: metastatic epidural spinal cord compression, 125I brachytherapy, radiotherapy, surgical decompression and spine stabilization, prognosis

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