A comparison of spinal laser interstitial thermotherapy with open surgery for metastatic thoracic epidural spinal cord compression

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  • 1 Departments of Neurosurgery,
  • 3 Radiation Oncology, and
  • 4 Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
  • 2 Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California

OBJECTIVE

The proximity of the spinal cord to compressive metastatic lesions limits radiosurgical dosing. Open surgery is used to create safe margins around the spinal cord prior to spinal stereotactic radiosurgery (SSRS) but carries the risk of potential surgical morbidity and interruption of systemic oncological treatment. Spinal laser interstitial thermotherapy (SLITT) in conjunction with SSRS provides local control with less morbidity and a shorter interval to resume systemic treatment. The authors present a comparison between SLITT and open surgery in patients with metastatic thoracic epidural spinal cord compression to determine the advantages and disadvantages of each method.

METHODS

This is a matched-group design study comprising patients from a single institution with metastatic thoracic epidural spinal cord compression that was treated either with SLITT or open surgery. The two cohorts defined by the surgical treatment comprised patients with epidural spinal cord compression (ESCC) scores of 1c or higher and were deemed suitable for either treatment. Demographics, pre- and postoperative ESCC scores, histology, morbidity, hospital length of stay (LOS), complications, time to radiotherapy, time to resume systemic therapy, progression-free survival (PFS), and overall survival (OS) were compared between groups.

RESULTS

Eighty patients were included in this analysis, 40 in each group. Patients were treated between January 2010 and December 2016. There was no significant difference in demographics or clinical characteristics between the cohorts. The SLITT cohort had a smaller postoperative decrease in the extent of ESCC but a lower estimated blood loss (117 vs 1331 ml, p < 0.001), shorter LOS (3.4 vs 9 days, p < 0.001), lower overall complication rate (5% vs 35%, p = 0.003), fewer days until radiotherapy or SSRS (7.8 vs 35.9, p < 0.001), and systemic treatment (24.7 vs 59 days, p = 0.015). PFS and OS were similar between groups (p = 0.510 and p = 0.868, respectively).

CONCLUSIONS

The authors’ results have shown that SLITT plus XRT is not inferior to open decompression surgery plus XRT in regard to local control, with a lower rate of complications and faster resumption of oncological treatment. A prospective randomized controlled study is needed to compare SLITT with open decompressive surgery for ESCC.

ABBREVIATIONS cEBRT = conventional external-beam radiation therapy; EBL = estimated blood loss; ESCC = epidural spinal cord compression; iMRI = intraoperative MRI; KPS = Karnofsky Performance Scale; LOS = length of stay; OS = overall survival; PFS = progression-free survival; SLITT = spinal laser interstitial thermotherapy; SSRS = spinal stereotactic radiosurgery.

Supplementary Materials

    • Supplemental Table 1 and Fig. 1 (PDF 444 KB)

Contributor Notes

Correspondence Claudio Esteves Tatsui: The University of Texas MD Anderson Cancer Center, Houston, TX. cetatsui@mdanderson.org.

INCLUDE WHEN CITING Published online January 3, 2020; DOI: 10.3171/2019.10.SPINE19998.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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