Study Design A multicenter retrospective cohort study using prospectively collected data. Objectives Radiotherapy (RT) is the standard treatment for spinal metastases; however, the optimal timing of RT in patients requiring surgery remains unclear. This study compared the clinical outcomes of palliative surgery according to RT timing. Methods Among 413 patients screened across 35 centers, 146 patients with spinal metastases limited to the spine who underwent palliative surgery were included. Patients were classified into three groups based on RT timing: preoperative RT, postoperative RT, and no RT. Short-term outcomes were compared among the three groups. Results Of the 146 patients (preoperative RT: n = 42; postoperative RT: n = 59; no RT: n = 45), baseline characteristics and postoperative functional outcomes were comparable between the postoperative RT and no RT groups. Preoperative opioid use was significantly more frequent in the preoperative RT group. Postoperative complications were more common in the preoperative RT group. Functional outcomes improved in all groups; however, greater improvements in pain and numbness were observed in the nonpreoperative RT group than in the preoperative RT group, with a significant difference noted in numbness improvement. Conclusions Postoperative recovery after palliative surgery was largely comparable among the three groups. Although greater improvements in pain and numbness were observed in patients who did not receive preoperative RT, the clinical impact of preoperative RT in patients with mechanical instability remains uncertain. Postoperative wound complications were more frequent in the preoperative RT group, but these findings should be interpreted with cautiously given the limited number of events.
Kawamura et al. (2026) studied this question.