Abstract：
OBJECTIVE: Obtaining timely postoperative radiotherapy (RT) following separation surgery is critical to avoid local recurrence of disease yet can be a challenge due to scheduling conflicts, insurance denials, and travel arrangements. In patients undergoing metastatic spine surgery for spinal cord compression, the authors sought to: 1) report the rate of postoperative RT, 2) describe reasons for patients not receiving postoperative RT, and 3) investigate factors that may predict whether a patient receives postoperative RT.
METHODS: A single-center retrospective case series was undertaken of all patients who underwent metastatic spine surgery for extradural disease between January 2010 and January 2021. Inclusion criteria were patients with intermediate or radioresistant tumors with evidence of spinal cord compression who underwent surgery. The primary outcome was the occurrence of RT within 3 months following surgery. Multivariable logistic regression analysis was performed controlling for age, BMI, race, total number of decompressed levels, tumor size, other organ metastasis, and preoperative RT or chemotherapy to predict patients receiving postoperative RT.
UNASSIGNED: Of 239 patients undergoing spine surgery for metastatic disease, 113 (47.3%) received postoperative RT while 126 (52.7%) did not. In the postoperative RT group, 24 (21.2%) received stereotactic body radiation therapy while 89 (78.8%) received conventional external-beam radiation therapy. The most common reasons for patients not receiving postoperative RT included death or transfer to hospice (31.0%), RT not being recommended by radiation oncology (30.2%), and loss to follow-up (23.8%). On critical review with the radiation oncology department, the authors estimated that 101 of 126 (80.2%) patients who did not receive postoperative RT were potential candidates for postoperative RT. Patients who received postoperative RT had more documented inpatient (48.7% vs 32.5%, p < 0.001) and outpatient (100.0% vs 65.1%, p < 0.001) radiation oncology consultations than those who did not. Additionally, patients who received postoperative RT had a higher rate of postoperative chemotherapy (53.1% vs 25.4%, p < 0.001), while patients who did not receive postoperative RT had a higher rate of preoperative RT (7.1% vs 31.0%, p < 0.001). Multivariable analysis confirmed that patients who received preoperative RT had lower odds of undergoing postoperative RT (OR 0.14, 95% CI 0.06-0.34; p < 0.001), and patients who underwent postoperative chemotherapy had higher odds of undergoing postoperative RT (OR 3.83, 95% CI 2.05-7.17; p < 0.001).
CONCLUSIONS: In the current study reflecting real-world care of patients with metastatic spine disease after undergoing separation surgery, 47% of patients did not receive postoperative RT, and 80% of those patients were potential candidates for postoperative RT. Radiation oncology consultation and postoperative chemotherapy were significantly associated with receiving postoperative RT, whereas preoperative RT was significantly associated with not receiving postoperative RT. The lack of timely postoperative RT highlights a potential gap in metastatic spine tumor care and underscores the necessity for prompt radiation oncology consultation and effective planning.
METHODS: A single-center retrospective case series was undertaken of all patients who underwent metastatic spine surgery for extradural disease between January 2010 and January 2021. Inclusion criteria were patients with intermediate or radioresistant tumors with evidence of spinal cord compression who underwent surgery. The primary outcome was the occurrence of RT within 3 months following surgery. Multivariable logistic regression analysis was performed controlling for age, BMI, race, total number of decompressed levels, tumor size, other organ metastasis, and preoperative RT or chemotherapy to predict patients receiving postoperative RT.
UNASSIGNED: Of 239 patients undergoing spine surgery for metastatic disease, 113 (47.3%) received postoperative RT while 126 (52.7%) did not. In the postoperative RT group, 24 (21.2%) received stereotactic body radiation therapy while 89 (78.8%) received conventional external-beam radiation therapy. The most common reasons for patients not receiving postoperative RT included death or transfer to hospice (31.0%), RT not being recommended by radiation oncology (30.2%), and loss to follow-up (23.8%). On critical review with the radiation oncology department, the authors estimated that 101 of 126 (80.2%) patients who did not receive postoperative RT were potential candidates for postoperative RT. Patients who received postoperative RT had more documented inpatient (48.7% vs 32.5%, p < 0.001) and outpatient (100.0% vs 65.1%, p < 0.001) radiation oncology consultations than those who did not. Additionally, patients who received postoperative RT had a higher rate of postoperative chemotherapy (53.1% vs 25.4%, p < 0.001), while patients who did not receive postoperative RT had a higher rate of preoperative RT (7.1% vs 31.0%, p < 0.001). Multivariable analysis confirmed that patients who received preoperative RT had lower odds of undergoing postoperative RT (OR 0.14, 95% CI 0.06-0.34; p < 0.001), and patients who underwent postoperative chemotherapy had higher odds of undergoing postoperative RT (OR 3.83, 95% CI 2.05-7.17; p < 0.001).
CONCLUSIONS: In the current study reflecting real-world care of patients with metastatic spine disease after undergoing separation surgery, 47% of patients did not receive postoperative RT, and 80% of those patients were potential candidates for postoperative RT. Radiation oncology consultation and postoperative chemotherapy were significantly associated with receiving postoperative RT, whereas preoperative RT was significantly associated with not receiving postoperative RT. The lack of timely postoperative RT highlights a potential gap in metastatic spine tumor care and underscores the necessity for prompt radiation oncology consultation and effective planning.
摘要：
目的：在分离手术后获得及时的术后放疗（RT）对于避免疾病局部复发至关重要，但由于排程冲突可能是一个挑战，保险否认，和旅行安排。在因脊髓压迫而接受脊柱转移性手术的患者中，作者试图：1)报告术后放疗率，2）描述患者未接受术后RT的原因，和3）调查可能预测患者是否接受术后RT的因素。
方法：对2010年1月至2021年1月间因硬膜外疾病而接受脊柱转移性手术的所有患者进行了单中心回顾性病例系列研究。纳入标准是接受手术的有脊髓压迫证据的中度或放射性肿瘤患者。主要结果是术后3个月内发生RT。多变量logistic回归分析进行控制年龄，BMI,种族,解压缩级别的总数，肿瘤大小,其他器官转移，术前放疗或化疗以预测术后接受放疗的患者。
■在239名因转移性疾病而接受脊柱手术的患者中，113（47.3％）接受了术后RT，而126（52.7％）没有。术后RT组,24例（21.2％）接受了立体定向放射治疗，而89例（78.8％）接受了常规的外部束放射治疗。术后未接受RT的患者最常见的原因包括死亡或转院（31.0%），放射肿瘤学不推荐RT（30.2%），和后续损失（23.8%）。在放射肿瘤科的严格审查中，作者估计,126例未接受术后RT的患者中,101例(80.2%)是术后RT的潜在候选者.接受术后RT的患者住院记录更多（48.7％vs32.5％，p<0.001）和门诊患者（100.0%vs65.1%，p<0.001）放射肿瘤学咨询比那些没有。此外,术后接受RT的患者术后化疗率较高(53.1%vs25.4%,p<0.001)，而未接受术后放疗的患者术前放疗率较高(7.1%vs31.0%,p<0.001)。多变量分析证实，术前接受RT的患者术后接受RT的几率较低（OR0.14，95％CI0.06-0.34；p<0.001），接受术后化疗的患者接受术后RT的几率更高（OR3.83，95％CI2.05-7.17；p<0.001）。
结论：在当前的研究中，反映了接受分离手术后脊柱转移性疾病患者的现实护理，47%的患者术后未接收RT，这些患者中有80％是术后RT的潜在候选人。放疗肿瘤学会诊和术后化疗与接受术后RT显著相关,而术前RT与术后未接受RT显著相关。缺乏及时的术后RT凸显了脊柱转移性肿瘤治疗中的潜在差距，并强调了及时进行放射肿瘤学咨询和有效计划的必要性。
方法：对2010年1月至2021年1月间因硬膜外疾病而接受脊柱转移性手术的所有患者进行了单中心回顾性病例系列研究。纳入标准是接受手术的有脊髓压迫证据的中度或放射性肿瘤患者。主要结果是术后3个月内发生RT。多变量logistic回归分析进行控制年龄，BMI,种族,解压缩级别的总数，肿瘤大小,其他器官转移，术前放疗或化疗以预测术后接受放疗的患者。
■在239名因转移性疾病而接受脊柱手术的患者中，113（47.3％）接受了术后RT，而126（52.7％）没有。术后RT组,24例（21.2％）接受了立体定向放射治疗，而89例（78.8％）接受了常规的外部束放射治疗。术后未接受RT的患者最常见的原因包括死亡或转院（31.0%），放射肿瘤学不推荐RT（30.2%），和后续损失（23.8%）。在放射肿瘤科的严格审查中，作者估计,126例未接受术后RT的患者中,101例(80.2%)是术后RT的潜在候选者.接受术后RT的患者住院记录更多（48.7％vs32.5％，p<0.001）和门诊患者（100.0%vs65.1%，p<0.001）放射肿瘤学咨询比那些没有。此外,术后接受RT的患者术后化疗率较高(53.1%vs25.4%,p<0.001)，而未接受术后放疗的患者术前放疗率较高(7.1%vs31.0%,p<0.001)。多变量分析证实，术前接受RT的患者术后接受RT的几率较低（OR0.14，95％CI0.06-0.34；p<0.001），接受术后化疗的患者接受术后RT的几率更高（OR3.83，95％CI2.05-7.17；p<0.001）。
结论：在当前的研究中，反映了接受分离手术后脊柱转移性疾病患者的现实护理，47%的患者术后未接收RT，这些患者中有80％是术后RT的潜在候选人。放疗肿瘤学会诊和术后化疗与接受术后RT显著相关,而术前RT与术后未接受RT显著相关。缺乏及时的术后RT凸显了脊柱转移性肿瘤治疗中的潜在差距，并强调了及时进行放射肿瘤学咨询和有效计划的必要性。
