Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review Journal Article
| Authors: | Itshayek, E.; Yamada, J.; Bilsky, M.; Schmidt, M.; Shaffrey, C.; Gerszten, P.; Polly, D.; Gokaslan, Z.; Varga, P. P.; Fisher, C. G. |
| Article Title: | Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review |
| Abstract: | The last decade has witnessed a dramatic change in management of metastatic spine disease, with an increased role for surgery and emerging use of stereotactic radiotherapy, often in combination. Patients may be treated with radiotherapy followed by surgery, or have surgery and then adjuvant radiotherapy. In both cases, the surgeon and oncologist need to select the optimal timing for surgery and radiotherapy to minimize wound complications while obtaining maximum oncolytic effects. The purpose of this review was to determine the optimal timing of surgery and radiotherapy in patients surgically treated for spinal metastases. A systematic review utilizing Medline, Embase, Paper First, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews was performed. References were screened to further identify relevant studies and basic science literature reviewed. A total of 46 reports discussing the timing of surgery after radiotherapy, describing experience in 5836 patients, were identified. Only one retrospective study addressed the research question and suggested that surgery within seven days of radiation increases the rate of postoperative wound complications. Timing of adjuvant radiotherapy following surgery was addressed in 51 reports describing 7090 patients. None of the studies specifically answered the research question. The time interval between radiotherapy and surgery was reported as 5-21 days in nine studies. Based on this systematic review together with the understanding of general principles of wound healing and effects of radiation on wound healing, the optimal radiotherapy-surgery/surgery-radiotherapy time interval should be at least one week to minimize wound complications. |
| Keywords: | cancer surgery; review; nonhuman; clinical trials as topic; cancer radiotherapy; combined modality therapy; radiotherapy, adjuvant; research design; internet; retrospective study; postoperative complication; wound healing; systematic review; radiosurgery; spine; spinal neoplasms; surgical infection; databases, bibliographic; antiangiogenic therapy; neoplasm metastasis; collagen; brachytherapy; fibroblast; medical oncology; medline; medical literature; cochrane library; corticosteroid; adjuvant radiotherapy; wound dehiscence; liquorrhea; skin necrosis; spine metastasis; embase; metastatic spine disease; laminectomy; stereotactic radiotherapy; spinal cord decompression |
| Journal Title: | International Journal of Oncology |
| Volume: | 36 |
| Issue: | 3 |
| ISSN: | 1019-6439 |
| Publisher: | Spandidos Publications |
| Date Published: | 2010-03-01 |
| Start Page: | 533 |
| End Page: | 544 |
| Language: | English |
| DOI: | 10.3892/ijo-00000527 |
| PUBMED: | 20126972 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 20 April 2011" - "CODEN: IJONE" - "Source: Scopus" |
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