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Summary: A new study shows that surgery and radiation are better than radiation alone to treat patients whose cancer has spread to the spinal cord. Patients who received the combined treatment were more likely to walk and retain normal bladder function, researchers report in The Lancet.

Why it's important: Each year, more than 20,000 people in the US with advanced cancer have the cancer spread to their spinal cord. This is a devastating problem. Not only does it cause severe back pain, the spinal cord becomes damaged and many patients end up unable to walk or control their urine.

What's already known: In the past, treatment with radiation seemed as effective as surgery. The type of surgery commonly used, called laminectomy, removed the back parts of the spinal bones to get at the cancer. Because post-operative recovery was slow, most doctors recommended radiation instead, since it was equally effective. But in the early 1980s, a new surgery that approached the tumor from the front or side of the spinal cord was developed. This seemed more effective than radiation, but doctors couldn't be certain. This study was done to answer which is better.

How this study was done: Once the diagnosis of cancer spread to the spinal cord was made and patients consented to participate in the study, they were divided by random assignment into 2 groups. Patients in one group were treated only with radiation therapy to the tumor, while patients in the other group underwent surgery. Both treatments were begun within 24 hours. The group receiving surgery then also got radiation that started about 14 days after the surgery.

What was found: Patients who had both surgery and radiation fared better. After treatment, 84% of the patients in the combined therapy group were able to walk compared with 57% in the radiation only group. They also had less pain and were more likely to retain their bladder control. Patients who received the combined therapy didn't have to spend any more time in the hospital than people who got only radiation. They also lived longer (126 days vs. 100 days).

The bottom line: Most patients with cancer that has spread to their spinal cord should receive surgery first, followed by radiation. Radiation alone is less likely to keep them walking and retaining bladder control.

Citation: "Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial." Published in the Aug. 20, 2005, issue of The Lancet, (Vol. 366, No. 9486: 643-648). First author: Roy Patchell, MD, University of Kentucky Medical Center.