• Ibrahim Hussain, Jacob L Goldberg, Joseph A Carnevale, Samuel Z Hanz, Anne S Reiner, Adam Schmitt, Daniel S Higginson, Yoshiya Yamada, Ilya Laufer, Mark H Bilsky, and Ori Barzilai.
• Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
• Neurosurgery. 2022 Feb 1; 90 (2): 199206199-206.

BackgroundThe management of spinal metastatic renal cell carcinoma (mRCC) is controversial regarding extent of resection and radiation dosing.ObjectiveTo determine outcomes in patients treated with hybrid therapy (separation surgery plus adjuvant stereotactic body radiation therapy [SBRT]) for mRCC.MethodsA retrospective study of a prospectively collected cohort of patients undergoing hybrid therapy for mRCC between 2003 and 2017 was performed. SBRT was delivered as high-dose single-fraction, high-dose hypofractionated, or low-dose hypofractionated. Extent of disease, clinical and operative outcomes, and complications data were collected, and associations with overall survival (OS) and progression-free survival were determined.ResultsNinety patients with mRCC with high-grade epidural spinal cord compression (ESCC grades 2 and 3) were treated. Metastases were widespread, oligometastatic, and solitary in 56%, 33%, and 11% of patients, respectively. SBRT delivered was high-dose single-fraction, high-dose hypofractionated, and low-dose hypofractionated in 24%, 56%, and 20% of patients, respectively. The 1-yr cumulative incidence of major complications was 3.4% (95% confidence interval [CI]: 0.0%-7.2%). The median follow-up was 14.2 mo for the entire cohort and 38.3 mo for survivors. The 1-yr cumulative incidence of progression was 4.6% (95% CI: 0.2%-9.0%), which translates to a local control rate of 95.4% (95% CI: 91.0%-99.8%) 1 yr after surgery. The median OS for the cohort was 14.8 mo.ConclusionThese data support the use of hybrid therapy as a safe and effective strategy for the treatment of renal cell spine metastases.Copyright © Congress of Neurological Surgeons 2021. All rights reserved.

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