Impact of Targeted Systemic Therapy and Radiotherapy on Patients Undergoing Spine Surgery for Metastatic Renal Cell Carcinoma.
Hani Chanbour, Jeffrey W Chen, Gabriel A Bendfeldt, Lakshmi Suryateja Gangavarapu, Matthew E LaBarge, Mahmoud Ahmed, Iyan Younus, Soren Jonzzon, Steven G Roth, Silky Chotai, Brian I Rini, Leo Y Luo, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman
Author Information
Hani Chanbour: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Jeffrey W Chen: Vanderbilt University, School of Medicine, Nashville, TN, USA.
Gabriel A Bendfeldt: Vanderbilt University, School of Medicine, Nashville, TN, USA.
Lakshmi Suryateja Gangavarapu: Vanderbilt University, School of Medicine, Nashville, TN, USA.
Matthew E LaBarge: Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Mahmoud Ahmed: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
Iyan Younus: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Soren Jonzzon: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Steven G Roth: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Silky Chotai: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Brian I Rini: Division of Hematology Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
Leo Y Luo: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
Amir M Abtahi: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Byron F Stephens: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Scott L Zuckerman: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA scott.zuckerman@vumc.org.
BACKGROUND: In patients undergoing spine surgery for renal cell carcinoma (RCC), we sought to: (1) describe patterns of postoperative targeted systemic therapy and radiotherapy (RT), (2) compare perioperative outcomes among those treated with targeted systemic therapy to those without, and (3) evaluate the impact of targeted systemic therapy and/or RT on overall survival (OS) and local recurrence (LR). METHODS: A single-institution, retrospective cohort study of patients undergoing spine surgery for metastatic RCC from 2010 to 2021 was undertaken. Treatment groups were RT alone, targeted systemic therapy alone, dual therapy consisting of RT and targeted systemic therapy, and neither therapy. Multivariable Cox regression controlled for age, race, sex, insurance, and preoperative targeted systemic therapy. RESULTS: Forty-nine patients underwent spine surgery for RCC. Postoperatively, 4 patients (8%) received RT alone, 19 (38.8%) targeted systemic therapy alone, 12 (24.5%) dual therapy, and 13 (28.6%) neither. All groups were similar in demographics, preoperative Karnofsky Performance Score ( = 0.372), tumor size ( = 0.413), readmissions ( = 0.884), complications ( = 0.272), Karnofsky Performance Score ( = 0.466), and Modified McCormick Scale ( = 0.980) at last follow-up. Higher 1-year survival was found in dual therapy (83.3%) compared with other therapies. OS was significantly longer in patients with dual therapy compared with other therapies (log-rank; = 0.010). Multivariate Cox regression (HR = 0.08, 95% CI = 0.02-0.31, < 0.001) showed longer OS in dual therapy compared with other therapies. Seven patients (14.3%) experienced LR, and a similar time to LR was found between groups (log-rank; = 0.190). CONCLUSION: In patients undergoing metastatic spine surgery for RCC, postoperative dual therapy demonstrated significantly higher 1-year survival and OS compared with other therapies. CLINICAL RELEVANCE: Multidisciplinary management of metastatic RCC is necessary to ensure timely implementation of targeted systemic therapy and RT to improve outcomes. LEVEL OF EVIDENCE: 3:
