Efficacy of Total En Bloc Spondylectomy versus Stereotactic Ablative Radiotherapy for Single Spinal Metastasis

Simple Summary Spinal metastases denote the spreading of cancer into the spinal canal and causing of spinal cord compression. We compared the complete surgical removal of one or more vertebrae above the sacrum (total en bloc spondylectomy; TES) with the use of high radiation dose (stereotactic ablative radiotherapy; SABR) to eliminate spinal metastases. A total of 38 matched patients were analyzed (19 TES, 19 SABR) and the median follow-up period was 54.4 months (TES) and 26.1 months (SABR). Two-year progression-free survival (PFS) and overall survival (OS) rates were 66.7% and 78.9% in the TES group and 38.9% and 50.7% in the SABR group, respectively. The two matched groups showed no significant differences in OS and PFS. The rate of major complications was higher in the TES group than in the SABR group (21.1% vs. 10.5%). SABR resulted in fewer complications compared to TES, whereas TES demonstrated superior mid-term metastatic tumor control.Abstract To compare total en bloc spondylectomy (TES) with stereotactic ablative radiotherapy (SABR) for single spinal metastasis, we undertook a single center retrospective study. We identified patients who had undergone TES or SABR for a single spinal metastasis between 2000 and 2019. Medical records and images were reviewed for patient and tumor characteristics, and oncologic outcomes. Patients who received TES were matched to those who received SABR to compare local control and survival. A total of 89 patients were identified, of whom 20 and 69 received TES and SABR, respectively. A total of 38 matched patients were analyzed (19 TES and 19 SABR). The median follow-up period was 54.4 (TES) and 26.1 months (SABR) for matched patients. Two-year progression-free survival (PFS) and overall survival (OS) rates were 66.7% and 72.2% in the TES and 38.9% and 50.7% in the SABR group, respectively. At the final follow-up of the matched cohorts, no significant differences were noted in OS (p = 0.554), PFS (p = 0.345) or local progression (p = 0.133). The rate of major complications was higher in the TES than in the SABR group (21.1% vs. 10.5%, p = 0.660). These findings suggest that SABR leads to fewer complications compared to TES, while TES exhibits better mid-term control of metastatic tumors.