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