[KoK! Health] Why Surgery Is Necessary for Spinal Metastatic Cancer

A study has shown that surgery for spinal metastases should be actively considered. Seventy percent of cancer patients experience spinal metastasis. In the past, spinal metastases were considered terminal, and treatment was often abandoned despite severe pain. This is because as spinal metastases progress, patients have difficulty moving and their survival rates decrease.

X-ray and MRI images of a patient in their 50s who was unable to walk due to non-small cell lung cancer metastasizing to the spine. (Photo by Seoul St. Mary's Hospital)

Professor Kim Young-hoon (corresponding author) from the Department of Orthopedics at The Catholic University of Korea Seoul St. Mary's Hospital and Professor Park Hyung-yeol (first author) from the Department of Orthopedics at Eunpyeong St. Mary's Hospital published a paper in an international journal studying the importance of combined spinal surgery and radiotherapy for patients with non-small cell lung cancer (NSCLC) spinal metastases. They selected 22 patients who underwent combined spinal surgery and radiotherapy for spinal metastases from NSCLC between 2011 and 2017. These patients were then compared one-to-one through propensity score matching considering age, sex, life expectancy, and spinal instability with 22 patients out of 231 who received radiotherapy alone under similar conditions.

As a result, in the radiotherapy-only group, 5 patients (22.7%) showed worsening neurological symptoms due to pathological fractures. Additionally, in the group that underwent surgery and radiotherapy, 4 patients who were previously unable to walk regained the ability to walk, and 5 patients showed improvement in neurological symptoms.

Analysis of risk factors affecting the survival rate of the 44 patients included in the study revealed that the presence of mutations amenable to targeted anticancer therapy and the level of physical activity were significantly associated with survival. In particular, when comparing average survival rates, patients eligible for targeted anticancer therapy had an average survival of 21 months, whereas those treated with conventional chemotherapy had a much shorter average survival of 5 months.

Lung cancer is classified into non-small cell lung cancer (NSCLC) and small cell lung cancer based on size and morphology, with 80-85% being NSCLC. NSCLC metastasizes to the vertebrae through blood vessels or lymphatics. Metastatic cancer is usually diagnosed at stage 4, and while radiotherapy is the priority for treating both primary lung cancer and metastases, surgical treatment is necessary if the metastatic vertebrae are unstable or compress nerves causing paralysis.

The pain caused by spinal metastases differs from typical cancer pain, which worsens at night, as it mainly occurs during the day. This is because the vertebrae supporting the body move or change posture during the day, causing pain.

Professor Kim Young-hoon explained, "Patients with NSCLC metastasized to the spine are clinically common, but deciding on treatment methods is not easy. This study confirmed that surgical treatment not only prevents pathological fractures and long-term worsening of neurological symptoms but also improves walking ability and neurological symptoms through direct nerve decompression in patients with neurological deficits." He added, "Patients eligible for targeted anticancer therapy showed higher average survival rates. When neurological deficits or spinal instability occur, severe pain and paralysis symptoms prevent patients from walking and force them to remain bedridden. Therefore, we hope patients actively consider surgical treatment to relieve pain and participate in family gatherings or travel while overcoming cancer."

This content was produced with the assistance of AI translation services.