Comparative efficacy of total en-bloc spondylectomy and separation surgery followed by stereotactic body radiotherapy for isolated spinal metastases in lung cancer patients: a retrospective study

To compare the clinical efficacy between total en bloc spondylectomy (TES) and separation surgery combined with stereotactic body radiotherapy (SSRS) in patients with isolated spinal metastases secondary to NSCLC. A total of 85 NSCLC patients diagnosed with isolated spinal metastases were enrolled in this retrospective analysis. All patients received treatment between June 2018 and April 2022, among whom 25 patients underwent TES and the remaining 60 patients were managed with SSRS. Evaluated endpoints included local tumor control, PFS, OS, postoperative complications, and quality of life assessed via the SOSGOQ scale. TES yielded superior local tumor control and significantly prolonged PFS relative to SSRS. Nevertheless, the TES group presented larger intraoperative blood loss and a higher postoperative complication incidence. Specifically, cerebrospinal fluid leakage occurred in 20% of TES patients and pleural rupture in 12%, whereas both complications only accounted for 3.3% in the SSRS cohort. No significant intergroup difference was observed in OS. TES provides superior local tumor control and extended PFS for NSCLC patients with isolated spinal metastases, accompanied by increased intraoperative blood loss and higher complication risks. OS remains comparable between the two therapeutic modalities. Both approaches effectively improve patients’ postoperative quality of life. These outcomes highlight the necessity of multidisciplinary collaborative decision-making to individualize and optimize therapeutic strategies for this clinical population.