Top Line: Oh, renal cell carcinoma (RCC), that notoriously “radioresistant” disease.
The Study: Here is a look at outcomes over the past decade and a half with the use of separation surgery followed by radiation for RCC metastatic to the spine with high-grade compression (ESCC 2-3). It’s important to note that a majority of the 90 cases included were amidst widespread metastatic disease, so this is no oligomet study. Also of note, more than one in five had prior radiation at the same site. Now, what is meant by separation surgery? Pretty much what it sounds like: a decompressive laminectomy (+/- more complicated procedures for anterior disease) was performed to provide immediate cord relief without any intent to resect all visible cancer—again, because ablative radiation was always planned. Radiation commenced at a median of 25 days after surgery. About half of patients were prescribed 9 Gy x 3, another quarter 24 Gy x 1 and the rest a lower 3-5 fraction regimen. Local control one year after surgery was a very impressive 95% and at 2 years 92%. Major complications occurred in 11 patients (12%), mainly hardware failure (8%) and wound complications (3%).
TBL: Separation surgery followed by ablative radiation is an extremely effective treatment for high-grade cord compression from RCC spinal mets, even in the setting of widespread disease and prior radiation. | Hussain, Neurosurgery 2021