Clinical results of nonsurgical treatment for spinal metastases

Purpose: In contrast with many analyses of surgical treatment for spinal me tastases, there have been only a few recent well-documented publications as sessing nonsurgical treatment. This paper is a study of the outcome of nons urgical therapy for metastatic tumors of the spine. Methods and Materials: One hundred and one patients with spinal metastases were treated with radiation therapy and/or chemotherapy without surgical in tervention between 1990 and 1995, in prospective analysis, and had follow-u p for more than 24 months. This study included 59 men and 42 women with a m ean age of 61 years (range: 14 to 81). Mean follow-up periods were 11 month s for patients dying of the disease and 53 months for the survivors. Neurol ogical status, pain relief, functional improvement, and cumulative survival rate were assessed. Results: Of the total treated, 67 patients (66%) were evaluated as being ne urologically stable or improved after treatment. Pain relief was achieved i n 67%, and 64% showed functional improvement. Primary lesion responsiveness to nonsurgical therapy influenced the survival, neurological recovery, pai n control, and function. Neurological findings before therapy were useful i n predicting ambulatory status after treatment. Conclusion: Nonsurgical treatment was often successful when primary tumors had responsiveness to radiation therapy and/or chemotherapy. We found this to be evident even when neurological deficits were found, particularly in l umbar spines. Spinal metastases of tumors with less responsiveness, unless patients were neurologically intact, responded poorly to therapy. Most of t he patients who were successfully treated enjoyed relief lasting nearly unt il death. Their functional ability was limited by general debility, rather than by local tumor regeneration. (C) 1998 Elsevier Science Inc.