Effectiveness of Radiotherapy in Vertebral Bodies with Metastatic Lesions Previously Treated with Vertebroplasty: A Systematic Review of the Literature

Introduction: Metastatic spine disease is a major clinical challenge, often causing fractures, spinal cord compression, and pain. The spine is the third most common site for metastases, with up to 70% of patients experiencing bone pain. Treatment focuses on palliation, with vertebroplasty and radiotherapy as key options. Vertebroplasty stabilizes fractures and provides pain relief but lacks oncological efficacy. Radiotherapy is effective for pain and tumor control but does not prevent fractures. This study evaluates the combined safety and efficacy of vertebroplasty and radiotherapy for metastatic spinal neoplasms.

Methods: A systematic review and meta-analysis following PRISMA guidelines was conducted. Four databases (PubMed, Embase, Web of Science, and LILACS) were searched for studies on radiotherapy for metastatic vertebral lesions post-vertebroplasty. Studies published up to November 2024 were included. Criteria encompassed randomized and non-randomized studies comparing radiotherapy with or without vertebroplasty, reporting on fracture progression, tumor control, morbidity, and complications. Exclusion criteria included prior spinal surgery or insufficient data on fracture stability or tumor progression. Bias risk and quality were assessed using Cochrane and ROBINS-I tools.

Results: Four studies met the inclusion criteria, involving 137 patients and 305 vertebral bodies. Common metastases were from lung, breast, liver, and gastric cancers. Vertebral augmentation used an average of 4.1 mL of PMMA, and radiotherapy was delivered at a median dose of 36 Gy. Follow-up ranged from 9.7 to 12 months, with 29% of patients showing disease progression. All studies reported significant pain relief, and two showed improved oncological control. The Spinal Instability Neoplastic Score (SINS) showed minimal changes in stability, with no impact on surgical decisions in one study. Vertebroplasty followed by radiotherapy did not show clear improvements in stability or oncological control.

Conclusion : Vertebroplasty with radiotherapy shows promise for pain relief and tumor control in metastatic spine disease. However, in combination, the evidence remains inconclusive regarding its impact on fracture stability and long-term oncological outcomes. Further studies are needed to assess the safety, long-term efficacy, and potential benefits in preventing spinal deformities and local cancer control.