Introduction: Spinal metastases, affecting up to 10% of cancer patients and often presenting as multiple lesions, are the most common tumors of the vertebral column. Stereotactic radiosurgery (SRS) is an established treatment for brain and spinal metastases, yet robust evidence on its safety and efficacy in cases of spinal cord compression, progression-free survival, and Karnofsky status remains limited. This study aims to systematically assess SRS's safety and efficacy in treating spinal metastases, providing clarity on these clinical aspects.
Methods: Following Cochrane and PRISMA guidelines, a search was performed in Medline, Embase, and Cochrane databases. Eligible studies included randomized or observational studies with ≥4 patients reporting on SRS for the treatment of spinal metastasis. A random-effects model was used to calculate a single-proportion analysis with 95% confidence intervals.
Results: Thirty-seven studies involving 2,209 patients were selected. The progression-free survival rate (PFS) at 1 year was 79% (95% CI: 72 to 85), at 2 years was 73% (95% CI: 60 to 85), and at 3 years was 55% (95% CI: 37 to 73). 224 of 544 patients, 35% (95% CI: 14 to 58), demonstrated some neurological improvement. Spinal recurrence was observed in 18% (95% CI: 13 to 24) of cases. 14 of 252 patients experienced permanent postoperative deficits, 5% (95% CI: 2 to 9). The overall survival rate (OS) at 6 months was 66% (95% CI: 54 to 78), at 1 year was 56% (95% CI: 46 to 67), at 2 years was 51% (95% CI: 33 to 69), and at 3 years was 36% (95% CI: 30 to 42).
Conclusion : SRS is a safe and effective option for the treatment of spinal metastases. Future studies should take into account the primary lesion type and consider multiple variables, such as spinal stability, ambulatory status, prognosis, and Karnofsky performance status, to further refine treatment strategies and outcomes.
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