A novel strategy of "Separation Surgery Combined with Vertebroplasty and Interstitial Implantation of 125I Seeds (SSVPI)" in managing thoracic metastases from lung adenocarcinoma with spinal cord compression.

BACKGROUND

Prolonged survival from targeted/immunotherapy in lung adenocarcinoma has made thoracic metastatic epidural spinal cord compression a critical challenge. This study evaluated a novel surgical strategy, separation surgery combined with vertebroplasty and ¹²⁵I seeds implantation (SSVPI), in this cohort.

METHODS

Seventy-eight patients with lung adenocarcinoma and thoracic vertebral metastases underwent SSVPI. VAS and KPS were assessed preoperatively and at 1 week, 1, 3, 6, and 12 months postoperatively using repeated measures ANOVA. ASIA and ECOG scores were compared before and 3 months after surgery by the Wilcoxon test. OS, PFS, and LPFS were estimated by the Kaplan-Meier method, and Cox regression identified prognostic factors for LPFS.

RESULTS

Significant postoperative improvements in pain and functional status were observed (P < 0.001). VAS improved from 7.83 ± 1.34 preoperatively to 1.86 ± 1.48 at 1 week and 2.79 ± 1.24 at 12 months; KPS from 41.41 ± 9.14 to 74.87 ± 15.79 and 71.54 ± 14.48. ASIA and ECOG improvement rates were 91.0% and 94.9%, respectively. Detected mutations included EGFR (48.7%), ALK (15.4%), RET (6.4%), and ROS1 (7.7%). Median OS was 33.5 months, median PFS 16.8 months, and median LPFS was not reached. Complication rate was 19.2% (13 cement leaks, 2 seed migrations).

CONCLUSIONS

SSVPI is an integrated strategy coupling spinal cord decompression with interstitial ¹²⁵I brachytherapy and vertebroplasty, thus providing minimally invasive decompression, immediate analgesia, local tumor control, and partial spinal stabilization for patients with lung adenocarcinoma and thoracic metastatic epidural spinal cord compression.