Patchell MSCC trial

Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial

Patchell RA, Tibbs PA, Regine WF, et al. Lancet (London, England) 2005 · PMID 16112300 · doi:10.1016/s0140-6736(05)66954-1

Question

Does direct decompressive surgery followed by radiotherapy improve outcomes over radiotherapy alone in metastatic spinal cord compression?

Design

Multicentre RCT in US centres, stopped early for efficacy at interim analysis.

Patients

Adults with MRI-confirmed metastatic epidural spinal cord compression at a single area, not paraplegic for more than 48 hours, excluding radiosensitive tumours.

Intervention

Direct circumferential decompressive surgery followed by radiotherapy

Comparison

Radiotherapy alone

Primary outcome

Ability to walk after treatment

Key result

Surgery plus radiotherapy significantly improved the proportion able to walk and the duration of walking, and more patients who were non-ambulant at presentation regained walking; corticosteroid and opioid needs were also lower.

Limitations

Highly selected population with relatively good prognosis and small sample; radiosensitive tumours and multilevel disease were excluded.

Impact on practice

Established surgical decompression and stabilisation plus radiotherapy for suitable MSCC patients, informing NICE recommendations and the role of the MSCC coordinator.