J Korean Neurosurg Soc.  2015 Jan;57(1):42-49. 10.3340/jkns.2015.57.1.42.

Surgical Management with Radiation Therapy for Metastatic Spinal Tumors Located on Cervicothoracic Junction : A Single Center Study

• Park HY
• Lee SH
• Park SJ
• Kim ES
• Lee CS
• Eoh W

• KMID: 2067090
• DOI: http://doi.org/10.3340/jkns.2015.57.1.42

Abstract

OBJECTIVE
The cervicothoracic junction (CTJ) is a biomechanically and anatomically complex region that has traditionally posed problems for surgical access. In this retrospective study, we describe our clinical experiences of the treatment of metastatic spinal tumors at the CTJ and the results.
METHODS
From June 2006 to December 2011, 23 patients who underwent surgery for spinal tumors involving the CTJ were enrolled in our study. All of the patients were operated on through the posterior approach, and extent of resection was classified as radical, debulking, and simple neural decompression. Adjuvant radiation therapy (RT) was also considered. Visual analog scale score for pain assessment and Medical Research Council (MRC) grade for motor weakness were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG).
RESULTS
Almost all of the patients were operated using palliative surgical methods (91.3%, 21/23). Ten complications following surgery occurred and revision was performed in four patients. Of the 23 patients of this study, 22 showed significant pain relief according to their visual analogue scale scores. Concerning the aspect of neurological and functional recovery, mean MRC grade and ECOG score was significantly improved after surgery (p<0.05). In terms of survival, radiation therapy had a significant role. Median overall survival was 124 days after surgery, and the adjuvant-RT group (median 214 days) had longer survival times than prior-RT (63 days) group.
CONCLUSION
Although surgical procedure in CTJ may be difficult, we expect good clinical results by adopting a palliative posterior surgical method with appropriate preoperative preparation and postoperative treatment.

Keyword

Metastatic spinal tumor; Cervicothoracic junction; Treatment

MeSH Terms

Decompression
Humans
Pain Measurement
Retrospective Studies
Visual Analog Scale

Figure

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  Fig. 1 Annual prevalence of perioperative mortality and morbidity during enrolled period.

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  Fig. 2 Overall survival of 23 patients underwent surgery for spinal metastases involving the cervicothoracic junction. Median overall survival was 124 days (95% CI, 50.4-197.6).

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  Fig. 3 A : Survival of 23 patients received surgery for cervicothoracic junction (CTJ) metastasis according to whether prior-RT was performed (log-rank test; p=0.808). B : Survival of 23 patients received surgery for CTJ metastasis according to whether adjuvant-RT was performed (log-rank test; p=0.002). C : Survival of 20 patients excluding 3 patients received prior-RT and adjuvant-RT according to RT timing (no RT vs. prior RT only vs. adjuvant RT only; log-rank test; p=0.025). RT : radiation therapy.

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