From the Guidelines
The Patchell study has the potential to change the management of selected patients with metastatic spinal cord compression (MSCC) [ 1 ].
Key Findings
- The study compared surgery plus radiation therapy (RT) to RT alone in patients with MSCC, with results suggesting that surgery plus RT may be beneficial for selected patients [ 1 ].
- However, the outcomes of the RT alone arm were worse than expected compared to other prospective RT alone trials [ 1 ].
- The study's findings are unclear on whether surgery plus RT is better for selected patients or if RT for patients with spinal instability produces worse outcomes [ 1 ].
Clinical Implications
- Patients who deteriorate neurologically or recompress after RT should be considered for surgery [ 1 ].
- Patients who recompress in-field after RT may be considered for reirradiation, especially if it has been more than 6 weeks since the completion of their last course [ 1 ].
Limitations
- The study's results are limited by the high complication rates and long convalescent periods associated with surgery, which may impact the decision to recommend surgery for palliation [ 1 ].
From the Research
Findings of the Patchell Study
The Patchell study, published in 2005, established surgical decompression followed by adjuvant radiotherapy as the standard of care for patients with spinal cord compression caused by metastatic cancer 2. The study found that surgical decompression can improve survival and functional outcomes in patients with spinal metastases.
Key Results
- The Patchell trial demonstrated a significant benefit of surgical decompression in patients with spinal metastasis, leading to increased survival and improved functional outcomes 3.
- A comparative analysis of outcomes of surgical options for spinal metastatic disease found distinct complication profiles and quality outcomes associated with the selection of surgical approach 2.
- The study by Patchell et al. showed that surgery is often one component of a multimodal treatment approach, including chemotherapy and radiation, which can make it difficult to parse the benefits of each individual treatment in outcome studies 4.
Impact on Clinical Practice
- The publication of the Patchell RCT led to an increase in the rate of spine surgery for patients with spinal metastasis, from an average of 3.8% to 4.9% surgeries per metastatic admission per year 3.
- The study's findings have been used to inform treatment strategies for patients with spinal metastases, with a growing emphasis on patient-reported outcomes and validated tools to assess outcomes 4.
Complications and Outcomes
- The Patchell study found that patients undergoing corpectomy had a greater 30-day postoperative complication rate, driven by increased rates of postoperative anemia and pulmonary complications 2.
- The study also found that total index hospitalization and 30-day payments were greatest among patients undergoing combined procedures and lowest for patients undergoing laminectomy alone 2.