PT  - JOURNAL ARTICLE
AU  - Hani Chanbour
AU  - Jeffrey W. Chen
AU  - Gabriel A. Bendfeldt
AU  - Lakshmi Suryateja Gangavarapu
AU  - Matthew E. LaBarge
AU  - Mahmoud Ahmed
AU  - Iyan Younus
AU  - Soren Jonzzon
AU  - Steven G. Roth
AU  - Silky Chotai
AU  - Brian I. Rini
AU  - Leo Y. Luo
AU  - Amir M. Abtahi
AU  - Byron F. Stephens
AU  - Scott L. Zuckerman
TI  - Impact of Targeted Systemic Therapy and Radiotherapy on Patients Undergoing Spine Surgery for Metastatic Renal Cell Carcinoma
AID  - 10.14444/8608
DP  - 2024 Jun 01
TA  - International Journal of Spine Surgery
PG  - 343--352
VI  - 18
IP  - 3
4099  - https://www.ijssurgery.com/content/18/3/343.short
4100  - https://www.ijssurgery.com/content/18/3/343.full
SO  - Int J Spine Surg2024 Jun 01; 18
AB  - 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 (P = 0.372), tumor size (P = 0.413), readmissions (P = 0.884), complications (P = 0.272), Karnofsky Performance Score (P = 0.466), and Modified McCormick Scale (P = 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; P = 0.010). Multivariate Cox regression (HR = 0.08, 95% CI = 0.02–0.31, P < 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; P = 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.