Functional outcomes and survival after surgical stabilization for inoperable non-small-cell lung cancer with spinal metastasis of the thoracic and lumbar spines: a retrospective comparison between epidermal growth factor receptor-tyrosine kinase inhibitor and platinum-based chemotherapy groups.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the surgical results between targeted therapy and post-operative chemotherapy for patients with spinal metastasis of inoperable non-small-cell lung cancer (NSCLC). SETTING: Single-center study at an academic orthopedic department in Taiwan. METHODS: Sixty-five patients were treated surgically for spinal metastasis of inoperable NSCLC with long posterior instrumentation with or without posterior decompression according to the patient's neurologic status. Post-operative radiotherapy of the spinal lesion and targeted therapy or chemotherapy were done following surgery after the surgical wound healed. Post-operative clinical outcomes and survival were evaluated and compared between these two groups. The overall survival represented survival from the date of diagnosis to death. RESULTS: Thirty-five patients were grouped as the targeted therapy group and 30 patients as the chemotherapy group. The overall median survival times were 12.0 and 10.0 months in the targeted therapy and chemotherapy groups, respectively. Sixty-two patients were able to walk with or without an aid postoperatively. There was no significant difference observed between these two groups in terms of pain relief, neurologic improvement, ambulatory improvement, and survival. CONCLUSIONS: Surgical stabilization with or without laminectomy improved functional outcomes in patients with inoperable non-small-cell lung cancer, and post-operative functional outcomes were similar between chemotherapy and targeted therapy groups. A longer survival was observed with targeted therapy for the patients whose NSCLC was diagnosed before spinal metastasis, however, the longer survival was not statistically significant.