Surgery or radiotherapy for epidural metastases

Surgery might possibly result in greater likelihood of ability to walk compared to radiotherapy in patients with epidural metastases, but there is no evidence from randomized trials.

A systematic review including 28 cohort studies with a total of 1542 subjects (of whom 999 had surgery) was abstracted in DARE. People receiving surgery were 1.3 times more likely to be ambulatory after treatment: 85% surgery versus 64% radiotherapy (crude RR 1.28, 95% CI: 1.20, 1.37, P<0.001). Significant heterogeneity was present in the meta-analysis for this outcome (P<0.001). Age, gender, primary pathology and lesion distribution did not statistically significantly influence these findings. People receiving surgery were twice as likely to regain ambulatory function compared with those undergoing radiotherapy (crude RR 1.99, 95% CI: 1.63, 2.44, P<0.001), but there was significant heterogeneity (P<0.001).

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).

Ədəbiyyat

1. Klimo P, Thompson CJ, Kestle JR, Schmidt MH. meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease.Neuro-Oncology 2005;7:64-7.