178 Hybrid Surgery-Radiosurgery Therapy for Metastatic Epidural Spinal Cord Compression (MESCC)

Abstract

Abstract INTRODUCTION Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery (SRS) preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery-radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. METHODS Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by SRS were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median post-operative radiosurgery dose of 2700 cGy was delivered. The change in PRO three months after the hybrid therapy represented the primary study outcome. Pre- and post-operative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. RESULTS >One hundred and eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items “worst” and “right now” pain (P < 0.0001), and in all BPI constructs (severity, interference with daily activities, and Pain Experience, P < 0.001). The MDASI-SP demonstrated reduction in spine specific pain severity and interference with general activity (P < 0.001), along with decreased symptom interference (P < 0.001). CONCLUSION Validated PRO instruments showed that in patients with MESCC, hybrid separation surgery-radiosurgery therapy results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.