Long-term clinical outcomes of patients with colorectal cancer with metastatic epidural spinal cord compression treated with hybrid therapy (surgery followed by stereotactic body radiation therapy) Journal Article

   

Authors:	Chakravarthy, V. B.; Schachner, B.; Amin, A.; Reiner, A. S.; Yamada, Y.; Schmitt, A.; Higginson, D. S.; Laufer, I.; Bilsky, M. H.; Barzilai, O.
Article Title:	Long-term clinical outcomes of patients with colorectal cancer with metastatic epidural spinal cord compression treated with hybrid therapy (surgery followed by stereotactic body radiation therapy)
Abstract:	-BACKGROUND: Hybrid therapy, consisting of separation surgery followed by stereotactic body radiation therapy, has become the mainstay treatment for radioresistant spinal metastases. Histology-specific outcomes for hybrid therapy are scarce. In clinical practice, colorectal cancer (CRC) is particularly thought to have poor outcomes regarding spinal metastases. The goal of this study was to evaluate clinical outcomes for patients treated with hybrid therapy for spinal metastases from CRC.-METHODS: This retrospective study was performed at a tertiary cancer center. Adult patients with CRC spinal metastasis who were treated with hybrid therapy for highgrade epidural spinal cord or nerve root compression from 2005 to 2020 were included. Outcome variables evaluated included patient demographics, overall survival and progression-free survival, surgical and radiation complications, and clinical-genomic correlations.-RESULTS: Inclusion criteria were met by 50 patients. Progression of disease occurred in 7 (14%) patients at the index level, requiring reoperation and/or reirradiation at a mean of 400 days after surgery. Postoperative complications occurred in 16% of patients, with 3 (6%) requiring intervention. APC exon 14 and 16 mutations were found in 15 of 17 patients tested and in all 3 of 7 local failures tested. Twenty patients (40%) underwent further radiation due to disease progression at other spinal levels.-CONCLUSIONS: Hybrid therapy in patients with CRC resulted in 86.7% local control at 2 years after surgery, with limited complications. APC mutations are commonly present in CRC patients with spine metastases and may suggest worse prognosis. Patients with CRC spinal metastases commonly progress outside the index treatment level.
Keywords:	overall survival; bone metastasis; colorectal cancer; radiotherapy; spine; therapy; patterns; spine radiosurgery; spine oncology; hybrid; metastatic spinal cord compression; adenomatous polyposis coli gene mutation
Journal Title:	World Neurosurgery
Volume:	169
ISSN:	1878-8750
Publisher:	Elsevier Inc.
Date Published:	2023-01-01
Start Page:	E89
End Page:	E95
Language:	English
ACCESSION:	WOS:000914993200001
DOI:	10.1016/j.wneu.2022.10.053
PROVIDER:	wos
PUBMED:	36272727
PMCID:	PMC10414758
Notes:	Article -- Source: Wos

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