Comparison of the Therapeutic Efficacy of Surgery with or without Adjuvant Radiotherapy versus Radiotherapy Alone for Metastatic Spinal Cord Compression: A Meta-Analysis

BACKGROUND: Spinal metastases are 20 times more common than primary spinal tumors and often cause metastatic spinal cord compression (MSCC). Clinical manifestations (e.g., pain and neurologic dysfunction) adversely affect patients' quality of life. Radiotherapy (RT), chemotherapy, and surgery are the major therapeutic strategies for MSCC. There is some evidence that combining surgery with adjuvant RT may be a better option. METHODS: This meta-analysis compared the therapeutic efficacy of surgery (with or without adjuvant RT) with RT alone in treatment of MSCC. Comparative studies of surgery (with or without adjuvant RT) versus RT alone for the treatment of MSCC were retrieved from the MEDLINE, EMBASE, and Cochrane Library databases. Primary (1-year survival) and secondary (motor function and complications) outcomes were compared by meta-analysis. RESULTS: Of the 26 studies originally identified, 20 were excluded (not original research, lack of relevance, no group comparison, or lack of comparable data). Compared with RT alone, surgery (with or without adjuvant RT) was associated with improvement of ambulation (odds ratio = 1.74, 95% confidence interval = 1.35-2.25, P < 0.05), pain relief (odds ratio = 3.61, 95% confidence interval = 2.75-4.74, P < 0.05), and 1-year survival (odds ratio = 1.92; 95% confidence interval = 1.37-2.71, P < 0.01). No differences in regaining walking ability and substantially longer hospital stays were observed. Surgery showed better therapeutic efficacy than RT alone with regard to quality of life and life expectancy, without additional complications. CONCLUSIONS: Further studies are needed to investigate the effects of these interventions on quality of life and to identify the best therapeutic strategy for patients with MSCC.