S883
Clinical - Mixed sites & palliation
ESTRO 2026
Hospital University, Barcelona, Spain. 9 Hematology, Institut Català d’Oncologia, Barcelona, Spain. 10 Radiation Oncology, Hospital del Mar, Barcelona, Spain Purpose/Objective: Metastatic spinal cord compression (MSCC) is a true oncologic emergency requiring rapid, coordinated multidisciplinary decision-making. Surgical decompression followed by postoperative radiotherapy (RT) is associated with superior functional outcomes and survival. Nevertheless, surgical selection remains heterogeneous across institutions, and many patients undergo surgery without meaningful benefit. In 2017, a Multidisciplinary Spine Tumor Board (STB) (including Radiation Oncology, Neurosurgery, Neurology, Radiology, Medical Oncology, Hematology, Palliative Care and Rehabilitation physicians) was implemented at our center to optimize prognostic-driven decisions. We evaluated the impact of STB on surgical selection and outcomes. Material/Methods: We retrospectively reviewed consecutive MSCC patients treated with spinal surgery between 2014– 2021. Patients treated with RT alone were excluded. Two 3-year cohorts were defined: pre-STB (2014–2017) and STB (2018–2021).Variables assessed included age, sex, primary tumor, visceral metastases, Karnofsky Performance Status (KPS), spinal instability (SINS), spinal cord compression grade (Bilsky score), Rades prognostic score, neurological deficits, surgery technique and RT regimens. Overall survival (OS) was calculated from surgery date using Kaplan–Meier and variables were compared by log-rank. Independent predictors were identified via multivariable Cox regression. χ² test was used to compare selection of patients in STB. Results: 119 patients were included, 34 pre-STB and 69 post- STB. Median age was 59 (33-82), 59% were male. Median follow-up was 15.6 (01-136.9) months. Median OS was 15.6 months (95% CI: 10.8–20.7). OS rates at 6, 12, and 24 months were 73%, 59%, and 40% respectively (Figure 1). In the 3-year period after STB establishment, the number of surgeries increased (69 vs 34) with a non-significant OS improvement (15.8 vs 12.2 months; p: NS).On univariate analysis, improved OS was significantly associated with non–lung primary tumors, absence of visceral metastases, KPS >70, Rades group III, and 30Gy or SBRT regimens. In multivariable analysis, only Rades group (p=0.02) and visceral metastatic status (p=0.036) remained independent predictors of OS (Figure 1 and 2). We observe that variables associated with better
prognosis in the univariate and multivariate analyses were more prevalent among patients selected for surgery in the STB period. The proportion of patients with favorable prognosis (Rades II–III, p=0.006) undergoing surgery increased from 64.7% pre-STB to 85.5% STB (Figure 2).
Conclusion: A dedicated multidisciplinary STB optimizes surgical selection in MSCC, reducing non-beneficial procedures and enhancing overall oncologic value. This collaborative model may serve as a scalable strategy to enhance outcomes and care efficiency in advanced spine oncology. References: Patchell RA et al. N Engl J Med. 2005; 352:1202– 1210.Rades D et al. Int J Radiat Oncol Biol Phys. 2011; 80:173–179.Bilsky MH et al. Neurosurgery. 2010;66(6 Suppl):122–131. Keywords: Cord compression, surgery
Digital Poster 2460
Clinical outcome and toxicity of stereotactic radiotherapy in patients with brain metastases Sindhu nagaraja, Beatrix Hültenschmidt, Katja Lindel Department of radiation oncology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
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