Surgical resection in metastatic spinal cord compression

Abstract

1compare the effect of combined surgical decompression and radiotherapy with radiotherapy alone in patients with spinal cord compression caused by metastatic cancer. Because Patchell and colleagues deemed the inferiority of radiotherapy alone conclusive after an interim analysis, the study was prematurely ended after the inclusion of 101 patients. The two groups were well matched for most characteristics except median time from diagnosis of the primary tumour to development of metastatic epidural spinal cord compression. Such disease developed after a median of 7 months in the radiotherapy group compared with 3 months in the surgery group. We believe that this difference might constitute an important source of bias. It could reflect a difference in tumour biology between the two groups, suggesting that fewer patients with more aggressive and fast-growing tumours were allocated to the radiotherapy group than to the surgery group. Since fast-growing tumours are known to be especially sensitive to radiotherapy, patient allocation, rather than the intervention, might explain the inferiority of radiotherapy in this study.