Does Adjuvant Radiotherapy Impact Outcomes after Spinal Instrumentation for Craniocervical Junction Malignancies?

Objective: Spinal reconstruction after resection of invasive craniocervical junction malignancies is fraught with technical and management considerations. One challenge is if the need for postoperative radiotherapy should be considered in the reconstruction strategy and specifically if the timing of radiation therapy impacts the need for revision spinal instrumentation. There is little outcomes data in this specific patient population and no published data on this specific topic.

Methods: A retrospective chart review of all patients undergoing occipito-cervical fixation between 2011 and 2019 at our center was performed.

Results: A total of forty patients were identified for this study. Twenty-five patients had primary malignancies and 12 patients (30%) had metastatic tumors. Thirteen (33%) had a staged resection taking place in multiple operations during their hospital stay. Tumor resection was performed in nineteen (48%) patients, while only stabilization was performed in 21 patients (52%). Nine patients (23%) had expanded endoscopic transclival approaches for tumor resection, ten patients (25%) had an extreme lateral approach, and two patients (5%) had an anterior open approach. Seventeen patients (38%) had early postoperative radiation therapy (within 3 months) and 10 patients had delayed radiotherapy (between three months and one year for seven patients. The median follow-up for the study cohort was 18.8 months with a median overall survival of 20.3 months. The revision rate was 7.5% with a median time to revision surgery was 42 months. The administration of adjuvant radiotherapy nor did its timing relative to surgery impact the need for instrumentation revision on log-rank and cox-regression analyses (p > 0.05)

Conclusion: The need for revision surgery occurred infrequently. Postoperative radiation was not associated with hardware failure, indicating that the timing of radiation should be dictated by the diagnosis and can be initiated postoperatively without delay.

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Artikel online veröffentlicht:
15. Februar 2022