Combination of surgery and radiotherapy
Uitgangsvraag
Key question
What is the optimal timing of radiotherapy and surgery, with a view to proactively coordinating these treatments?
Aanbeveling
Recommendations
- Ensure low-threshold communication between the radiation oncologist and the spinal surgeon, with the aim of coordinating the optimal sequence of radiotherapy and surgery for the individual patient.
- Consider postoperative radiotherapy, with the interval between treatments determined by wound healing (recommended interval: at least one to two weeks, starting as soon as possible). Reasons to refrain from radiotherapy may include the availability of effective systemic therapy, the need for rapid initiation of systemic therapy, or recent prior radiotherapy.
- Postpone surgery for at least two weeks after recent radiotherapy. This may be waived in the case of progressive neurological deficits, as this constitutes an emergency indication. Such decisions should be made in a multidisciplinary team meeting (MDO in Dutch).
- For patients with a realistic chance of needing surgery in the future, consider designating the healthy soft tissues within the surgical area as "organs-at-risk." Such decisions should be made in an MDO.
Overwegingen
Considerations
Balans tussen gewenste en ongewenste effecten
Complications
Most studies comparing the sequence of radiotherapy (RT) and surgery for spinal metastases show no clinically relevant difference in wound complication rates between preoperative and postoperative RT (Kumar, 2020). Results were not presented in a way which made GRADE assessment possible, since often only significance or correlation (yes/no) was stated. Conclusions of the authors are depicted in table 2.
Table 2. Studies comparing the sequences of radiotherapy and surgery in patients with spinal metastasis (Kumar, 2020)
|
Study ID |
Study design |
Sequence (n) |
Conclusion of the authors |
|
Barzilai, 2019 |
Retrospective chart and imaging review |
Postoperative RT (63) Surgery on previously irradiated lesions (20) |
There was no reported correlation between pre- or post-operative radiotherapy and wound complications. |
|
Pielkenrood, 2018 |
Prospective cohort study |
Preoperative RT (91) Postoperative RT (51) |
No significant difference in wound complication rates was found between pre- and postoperative radiotherapy groups for spinal metastases. |
|
Carl, 2018 |
Retrospective review |
Preoperative RT (63) Postoperative RT (75) |
No significant association was found between timing of radiotherapy and wound complications. |
|
Wang, 2004 |
Retrospective cohort study |
Preoperative RT (84) Postoperative RT (24) |
No statistical difference was observed in wound complication rates between patients who received pre-operative radiotherapy and those who had surgery without prior radiotherapy, including if surgery followed RT within 6 weeks. |
|
Ghogawala, 2001 |
Retrospective case series |
Preoperative RT (28) Postoperative RT (34) |
No conclusions were shown regarding comparison of pre- and postoperative RT. |
|
Fourney, 2001 |
Retrospective cohort study |
Preoperative RT (9) Postoperative RT (7) |
No conclusions were shown regarding comparison of pre- and postoperative RT. |
|
Akeyson, 1996 |
Retrospective case series |
Preoperative RT (20) Postoperative RT (3) |
Most wound infections occurred in patients who had pre-operative radiotherapy. |
The systematic review by Schilling (2020) reported preoperative RT as a risk factor for wound complications (OR 2.51 (1.76–3.57)). Kim (2012) noted for surgery an overall complication rate of 29% (range 5-65%) but did also report preoperative RT as a risk factor for complications. For patients receiving preoperative RT, 40 to 67% experienced complications, compared to 33% of the patients which received postoperative RT. Of note, Kim (2012) investigated the optimal treatment approach for patients with metastatic spinal cord compression, who are often treated in an emergency setting.
The BLEND pilot study highlighted the safety and feasibility of pre-operative SBRT followed by surgical stabilization of unstable spinal metastases within 24 hours with no wound complications in 13 patients (Versteeg, 2018). In the SBRT plans used in the BLEND pilot, the radiation dose to the designated surgical area was actively minimized without compromising the dose constraints for the organs at risk. The clinical benefit of this approach is now tested within a multicenter RCT (Huele, 2023).
Lee (2018) conducted a survey with questionnaires to better understand the practice of radiation oncologists and spine surgeons with regards to the timing of radiation (conventional and stereotactic) and surgery for the management of spinal metastases. They concluded that the recommended interval between radiotherapy and surgery (and vice versa) should ideally be a minimum of 2 weeks.
Local control
The systematic review of Faruqi (2022), by the International Stereotactic Radiosurgery Society Practice shows high 1-year local control (LC) rates (88.9%) with low toxicity for postoperative spine SBRT. Patients with oligometastatic disease, radioresistant histology, paraspinal masses, or prior irradiation seem to benefit most. The International Stereotactic Radiosurgery Society advises an interval of 8–14 days after surgery before starting SBRT, and treatment should begin within 4 weeks after surgery (Faruqi, 2022).
In the narrative review by Redmond (2016), the authors reflect on conventional postoperative RT and postoperative SBRT. It is suggested that SBRT may be especially beneficial for radioresistant tumors (with radiographic LC rates for radio-resistant primaries varying from 60 to 100%). In conventional postoperative RT, radiographic LC (clinical pain, neurological function) ranged between 0 and 72%. The authors emphasize the importance of effective communication between radiotherapists and surgeons, using objective grading of neurological function.
All above mentioned systematic reviews included primarily studies with a retrospective design, prospective evidence is scarce. Due to the nature of the designs, outcomes are rarely standardized hampering comparability. All results should therefore be interpreted with caution.
Although the literature does not offer a definitive answer on the optimal timing between radiotherapy and surgery for patients with spinal metastases, certain patterns can be observed. If the interval between treatments is too short (< 1 week), there could be a higher risk for wound healing disturbances as the proliferation phase of the wound repair process is still severely disturbed. Conversely, if the intervals are too long (e.g. > 6 weeks) the beneficial effects of the treatment may come too late, for example a disastrous loss of local control after decompressive surgery when radiotherapy is administered too late and the tumor has again progressed locally. In both instances (interval too short, or interval too long) the patient may suffer clinical consequences with large impact on quality of life. Because of ethical reasons it is not expected that studies assessing the optimal interval between treatments will be conducted.
Discussion between the radiation oncologist and spine surgeon should go beyond just the timing of radiation and surgery, as other considerations can greatly facilitate the treatments of the other. Examples include discussing the use of carbon fiber implants in patients scheduled for postoperative stereotactic radiotherapy; consideration of separation surgery to safely enable SBRT in cases of epidural tumor growth from radioresistant tumors; and the use of preoperative planning MRI (if available) by spine surgeons to plan separation surgeries. Another topic of discussion is minimizing the risk of future complications in spinal metastases that are likely to respond well to radiation therapy but have a relatively high probability of developing symptoms later on, for example in lytic lesions that collapse weeks/months after radiotherapy and subsequently require surgery. For these locations potential wound complications can be prevented by treating the future posterior surgical field as an organ at risk during planning of the index radiotherapy. The decision to spare the surgical field should be carefully weighed, as sparing the potential operative field may lead to slightly higher radiation doses to other organs at risk.
Separation surgery
Because the probability of durable local control may be compromised by epidural disease contacting the spinal cord, a relatively new hybrid strategy of separation surgery followed by SBRT has been increasingly used to reduce complications (compared with vertebrectomy) and improve local control by creating a safe margin between tumor and spinal cord (Laufer, 2013, Amelink, 2025). Although this is an emerging trend, it requires the patient to be subjected to an invasive surgical procedure and associated complications. In the review of Van den Brande and colleagues, the benefit of (separation) surgery before SBRT was not irrefutable proven: four studies demonstrated that reducing the degree of MSCC before SBRT leads to improved local control, but five other studies reported good local control rates in patients with Bilsky grade 2 or 3 MSCC lesions with SBRT alone. No sufficient subgroup data was available to assess the outcomes in low- vs. high-grade MSCC, and no comparison could be made between SBRT with or without surgery in high-grade MSCC. Furthermore, for especially radioresistant tumors, ensuring adequate target coverage may improve local control after radiotherapy (Rades, 2011; De Meerleer, 2014). Surgery appears to influence quality of life: three studies reported statistically significant improvements after surgery that were sustained during follow-up, whereas quality of life in patients receiving radiotherapy alone remained stable or declined slowly. Conducting a randomized trial comparing these strategies (SBRT with or without separation surgery) would be challenging, as many radiation oncologists are unwilling to treat high-grade MESCC with SBRT due to spinal cord dose constraints. Delivering ablative doses in this setting risks radiation-induced myelopathy, while underdosing near the dural margin risks epidural progression. Potential strategies to address this include liberalizing cord constraints or adopting hypofractionation (e.g., 24 Gy in three fractions), both of which show promise (Ghia, 2018; Rothrock, 2020; see also module Management of asymptomatic spinal metastases).
Quality of the evidence
This question has been addressed using expert opinion, the expertise of the working group, other relevant publications, and existing agreements regarding the organization of care in the Netherlands.
Values and preferences of patients (and possibly their relatives/caregivers)
For selected patients with metastatic spinal disease, radiotherapy and surgery can be beneficial to provide palliation and the ability to remain mobile. Generally, patients value improved quality of life and the possibility of durable local tumor control. Potential risks, such as wound complications, should be discussed, as these may outweigh benefits for frail patients or those with extensive comorbidity. Involving patients and, where appropriate, their family in shared decision-making is recommended. For specific subgroups (e.g., elderly, multimorbid patients), preferences may differ, and treatment should be individualized as much as possible. A multidisciplinary approach is advised for patients requiring treatment of metastatic spinal disease.
Cost aspects
The working group anticipates that these recommendations will contribute to a reduction in complications as it has been shown that surgical site infection after surgery for spinal metastases is costly to treat (Atkinson, 2017). Consequently, they are expected to result in overall cost savings.
Health equity
The intervention is not expected to impact health equity, as all patients currently have equal access to these treatments.
Acceptability
Ethical acceptability
The working group identifies no major ethical concerns.
Sustainability
There is no specific sustainability aspects associated with this recommendation.
Feasibility
The feasibility of coordinated RT and surgery depends on multidisciplinary collaboration, local expertise, and logistics. This approach is already standard in specialized centers but may be challenging in less resourced settings. Feasibility may be limited by personnel capacity, experience, technical infrastructure (SBRT), or organizational barriers. Where feasible, integrated care pathways improve outcomes and should be implemented as standard practice. Medical specialists are encouraged to coordinate and establish clear leadership responsibilities among those involved in the care of patients with spinal metastases.
Onderbouwing
Background
Over the past two decades, the treatment strategy for spinal metastases has evolved significantly, largely due to the landmark Patchell study which demonstrated that spinal surgery followed by radiotherapy is more effective than radiation alone in patients with spinal metastases and neurological deficits (Patchell, 2005). Currently, there are four main indications for treating spinal metastases: obtaining local tumor control to prevent the occurrence of skeletal-related events, and addressing inflammatory pain, mechanical instability and neurological deficits – or any combination of these. Each indication has a specific or preferred treatment: local tumor control is primarily managed with (stereotactic) radiotherapy; biological tumor pain with palliative radiotherapy; mechanical instability with surgical stabilization; and neurological deficits with decompressive surgery. Since successful management of spinal metastases often involves a combination of treatments – for example, decompressive surgery to address neurological deficit followed by radiotherapy for palliation and local tumor control – the sequence and timing of these interventions are important to optimize clinical outcomes and minimize adverse events (Amelink, 2025). For instance, postoperative wound healing disturbances can largely be avoided by maintaining a 1–2-week interval between surgery and radiotherapy.
To facilitate planning of these sequential treatments it is imperative that spine surgeons and radiation oncologists communicate clearly and well in advance, agree on minimum intervals between treatments, and establish clear agreements on collaborative workflows. This module explores the interaction between spine surgery and radiation in the treatment of spinal metastases and advises on timing and precautions, and communication between specialists.
Summary of literature
Not applicable.
Search and select
An explorative search was conducted to answer the following question:
Which treatment sequence should be used in patients receiving both radiotherapy and surgery?
Table 1. PICO
| P (Patients) | Patients with symptomatic spinal metastases with or without neurological deficits |
| I (Intervention) | Preoperative radiotherapy |
| C (Comparison) |
Postoperative radiotherapy |
| O (Outomes) | Quality of life (critical), survival (important), progression free survival/Local control (important), pain (critical), neurological function (critical), complications (important) |
Search and select (Methods)
A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com and Ovid/Medline all. Both databases were searched from 2003 to May 19th, 2025 for systematic reviews. Systematic searches were completed using a combination of controlled vocabulary and natural language keywords. The overall search strategy was derived from the following primary search concepts: (1) spine metastasis; (2) radiotherapy; (3) surgery. Duplicates were removed using EndNote software. Due to the high number of hits, it was decided to focus on systematic reviews. After deduplication a total of 516 records were imported for title/abstract screening. Initially, nine reviews were selected based on title and abstract screening. After reading the full text, eight studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and one systematic review was included (Kumar, 2020), however results could not be evaluated using GRADE.
Four other reviews did not compare postoperative RT with preoperative RT, however results are worth mentioning as they provide information on complication risks when surgery and radiotherapy are combined (Schilling, 2020; Faruqi, 2022; Redmond, 2016 and Kim, 2012), which will be discussed in the Considerations.
- 1 - Amelink JJGJ, Bindels BJJ, Kasperts N, MacDonald SM, Tobert DG, Verlaan JJ. Radiotherapy and surgery: can this combination be further optimized for patients with metastatic spine disease? Oncologist. 2025 Jan 17;30(1):oyae359. doi: 10.1093/oncolo/oyae359. PMID: 39832131; PMCID: PMC11745020.
- 2 - Atkinson RA, Jones A, Ousey K, Stephenson J. Management and cost of surgical site infection in patients undergoing surgery for spinal metastasis. Journal of Hospital Infection. 2017 Feb 1;95(2):148-53.
- 3 - Faruqi S, Chen H, Fariselli L, Levivier M, Ma L, Paddick I, Pollock BE, Regis J, Sheehan J, Suh J, Yomo S. Stereotactic radiosurgery for postoperative spine malignancy: a systematic review and international stereotactic radiosurgery society practice guidelines. Practical radiation oncology. 2022 Mar 1;12(2):e65-78.
- 4 - Ghia AJ, Guha-Thakurta N, Hess K, Yang JN, Settle SH, Sharpe HJ, Li J, McAleer M, Chang EL, Tatsui CE, Brown PD. Phase 1 study of spinal cord constraint relaxation with single session spine stereotactic radiosurgery in the primary management of patients with inoperable, previously unirradiated metastatic epidural spinal cord compression. International Journal of Radiation Oncology* Biology* Physics. 2018 Dec 1;102(5):1481-8.
- 5 - Huele EH, van der Velden JM, Kasperts N, Eppinga WS, Grutters JP, Suelmann BB, Weening AA, Delawi D, Teunissen SC, Verkooijen HM, Verlaan JJ. Stereotactic Body radiotherapy and pedicLE screw fixatioN During one hospital visit for patients with symptomatic unstable spinal metastases: a randomized trial (BLEND RCT) using the Trials within Cohorts (TwiCs) design. Trials. 2023 May 4;24(1):307.
- 6 - Kim JM, Losina E, Bono CM, Schoenfeld AJ, Collins JE, Katz JN, Harris MB. Clinical outcome of metastatic spinal cord compression treated with surgical excision±radiation versus radiation therapy alone: a systematic review of literature. Spine. 2012 Jan 1;37(1):78-84.
- 7 - Kumar N, Madhu S, Bohra H, Pandita N, Wang SS, Lopez KG, Tan JH, Vellayappan BA. Is there an optimal timing between radiotherapy and surgery to reduce wound complications in metastatic spine disease? A systematic review. European Spine Journal. 2020 Dec;29(12):3080-115.
- 8 - Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, Bilsky MH. The NOMS framework: approach to the treatment of spinal metastatic tumors. The oncologist. 2013 Jun 1;18(6):744-51.
- 9 - Lee RS, Batke J, Weir L, Dea N, Fisher CG. Timing of surgery and radiotherapy in the management of metastatic spine disease: expert opinion. Journal of Spine Surgery. 2018 Jun;4(2):368.
- 10 - Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. The Lancet. 2005 Aug 20;366(9486):643-8.
- 11 - Rades D, Huttenlocher S, Bajrovic A, et al. Surgery followed by radiotherapy versus radiotherapy alone for metastatic spinal cord compression from unfavorable tumors. Int J Radiat Oncol Biol Phys. 2011;81(5):e861-e868.
- 12 - De Meerleer G, Khoo V, Escudier B, et al. Radiotherapy for renal-cell carcinoma. Lancet Oncol. 2014;15(4): e170-e177. doi:10.1016/S1470-2045(13)70569-2.
- 13 - Redmond KJ, Lo SS, Fisher C, Sahgal A. Postoperative stereotactic body radiation therapy (SBRT) for spine metastases: a critical review to guide practice. International Journal of Radiation Oncology* Biology* Physics. 2016 Aug 1;95(5):1414-28.
- 14 - Rothrock R, Pennington Z, Ehresman J, Bilsky MH, Barzilai O, Szerlip NJ, Sciubba DM. Hybrid therapy for spinal metastases. Neurosurgery Clinics. 2020 Apr 1;31(2):191-200.
- 15 - Schilling AT, Ehresman J, Huq S, Ahmed AK, Lubelski D, Cottrill E, Pennington Z, Shin JH, Sciubba DM. Risk factors for wound-related complications after surgery for primary and metastatic spine tumors: a systematic review and meta-analysis. World neurosurgery. 2020 Sep 1;141:467-78.
- 16 - Van den Brande R, Thijs D, Bilsky M, Peeters M, Billiet C, Van de Kelft E. Treatment of ambulatory patients with metastatic epidural spinal cord compression: a systematic review and meta-analysis. Journal of Neurosurgery: Spine. 2023 Oct 27;40(2):175-84.
- 17 - Versteeg AL, Van der Velden JM, Hes J, Eppinga W, Kasperts N, Verkooijen HM, Oner FC, Seravalli E, Verlaan JJ. Stereotactic radiotherapy followed by surgical stabilization within 24 h for unstable spinal metastases; a stage I/IIa study according to the IDEAL framework. Frontiers in oncology. 2018 Dec 20;8:626.
Evidence tables
Risk of Bias tables
Not applicable.
Table of excluded studies
|
Reference |
Reason for exclusion |
|
Potential harms of interventions for spinal metastatic disease |
Wong study design |
|
Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review |
Wrong study population |
|
Postoperative Stereotactic Body Radiation Therapy (SBRT) for Spine Metastases: A Critical Review to Guide Practice |
Wrong study design |
|
Timing of stereotactic radiosurgery and surgery and wound healing in patients with spinal tumors: A systematic review and expert opinions |
Wrong study population |
|
Stereotactic Radiosurgery for Postoperative Spine Malignancy: A Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines |
Wrong study design |
|
Clinical outcome of metastatic spinal cord compression treated with surgical excision ± radiation versus radiation therapy alone: A systematic review of literature |
wrong comparison |
|
Conventional Radiotherapy Timing and Wound Complication Avoidance After Surgery for Metastatic Spine Disease. A LatAm Modified Delphi Study |
Wong study design |
|
Risk Factors for Wound-Related Complications After Surgery for Primary and Metastatic Spine Tumors: A Systematic Review and Meta-Analysis |
wrong comparison |
Beoordelingsdatum en geldigheid
Publicatiedatum : 05-06-2026
Beoordeeld op geldigheid : 05-06-2026
Algemene gegevens
De ontwikkeling/herziening van deze richtlijnmodule werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd door de Stichting Kwaliteitsgelden Medisch Specialisten (SKMS). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.
Samenstelling werkgroep
Voor het ontwikkelen van de richtlijnmodule is in 2023 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van alle relevante specialismen (zie hiervoor de Samenstelling van de werkgroep) die betrokken zijn bij de zorg voor patiënten met wervelmetastasen.
Werkgroep
- dr. W. (Walter) Taal (voorzitter), neuroloog Erasmuc MC, Nederlandse Vereniging voor Neurologie
- drs. L. (Lena) van Iterson, AIOS-neuroloog Elisabeth-TweeSteden Ziekenhuis, Nederlandse Vereniging voor Neurologie
- drs. R.P.B. (Robin) Boltjes, neuroloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Neurologie
- Prof. dr. JJ. (Jorrit-Jan) Verlaan, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. J. (Jasper) van Tiel, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. V. (Vivian) Bongers, Nucleaire geneeskunde Diakonessenhuis Utretch, Nederlandse Vereniging voor Nucleaire Geneeskunde
- Prof. dr. R. (Ronald) Bartels, Neurochirurg Radboudumc, Nederlandse Vereniging voor Neurochirurgie
- dr. S.O. (Selma) Algra, Radioloog UMC Utrecht, Nederlandse Vereniging voor Radiologie
- drs. M.G.A. (Maaike) Schippers, radiotherapeut Instituut Verbeeten, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. J.M. (Joanne) van der Velden, radiotherapeut UMC Utrecht, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. M.S. (Marthe) Paats, longarts Erasmus MC, Nederlandse Vereniging voor Artsen voor Longziekten en TBC
- dr. P.F. (Paula) Ypma, Internist hematoloog Haga Ziekenhuis, Nederlandse Internisten Vereniging
- dr. F.Y.F.L. (Filip) de Vos, internist-oncoloog en kaderarts palliatieve zorg UMC Utrecht, Nederlandse Internisten Vereniging
- dr. M. (Marije) Vos- van der Hulst, revalidatiearts Sint Maartenskliniek, Nederlandse Vereniging van Revalidatieartsen (vanaf oktober 2025)
- Mevr. S (Silvie) Dronkers†, patiëntvertegenwoordiger, Stichting Darmkanker (tot oktober 2025)
- dr. T.A.R. (Tebbe) Sluis†, Revalidatiearts Rijndam, Nederlandse Vereniging van Revalidatieartsen (tot mei 2025)
Klankbordgroep
- Mevr. Manon Immerzeel, Verpleegkundig specialist Reinier de Graaf ziekenhuis, Verpleegkundigen en Verzorgenden Nederland
- drs. A. (Anita) Ophof, anesthesioloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Anesthesiologie
Met dank aan
- dr. J.H. (Jurgen) Runge, interventieradioloog, UMC Groningen, Nederlandse Vereniging voor Radiologie
Met ondersteuning van
- dr. J. (Josefien) Buddeke, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (vanaf juli 2024)
- dr. L. (Linda) Oostendorp, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (tot juli 2024)
- drs. B. (Beatrix) Vogelaar, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- dr. J. (Jing) de Haan-Du, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. D. (Danique) Middelhuis, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. A. (Alies) Oost, informatiespecialist, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.
Gemelde (neven)functies en belangen werkgroep
|
Naam WERKGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Jasper van Tiel |
Orthopedisch chirurg UMC Utrecht en Acibadem IMC |
geen |
geen |
geen |
geen |
geen |
geen |
22-11-2023 |
Geen restrictie |
|
Joanne van der Velden |
Radiotherapeut bij het UMC Utrecht, betaald |
Bestuurslid bij het Landelijk Platform Palliatieve Radiotherapie (NVRO), onbetaald |
Geen |
Geen |
Deelname aan 2 extern gefinancierde onderzoeken, zie onder |
Verwerven van erkenning speelt mee aan mijn deelname aan de werkgroep richtlijn Wervelmetastasen |
Geen overige belangen |
28-12-2023 |
Geen restrictie |
|
Jorrit-Jan Verlaan |
Orthopedisch chirurg, UMC Utrecht (0.4 Fte) |
Lid steering committee AO Spine Knowledge Forum Tumor (onbetaald maar met onkosten vergoeding). |
Hoe de richtlijn wordt vormgegeven staat los van mijn persoonlijke financiële belangen. Er zijn ook geen belangen voor SentryX hoe de richtlijn wordt vormgegeven. |
geen |
Ja. |
Ik heb nationale/internationale expertise/reputatie en een leerstoel op het gebied van de behandeling van wervelmetastasen. Een goed uitgevoerde richtlijn kan helpen deze expertise/reputatie meer exposure te geven maar de impact en eventuele belangenverstrengeling zijn mij onduidelijk. |
geen |
22-11-2023 |
Geen restrictie. Geen penvoerder bij module 'Inschatten overleving'. |
|
Filip de Vos |
Internist-oncoloog en kaderarts palliatieve zorg |
geen |
geen |
geen |
ja |
geen |
BMS Advisory Board; Faculty member ESMO CNS tumors; Quality of Care commission Dutch Society of Medical Oncology; |
20-12-2023 |
Geen restrictie. (In de richtlijn worden geen systemische therapien aanbevolen.) |
|
Maaike Schippers |
Radiotherapeut |
geen |
geen |
geen |
geen |
geen |
geen |
3-12-2023 |
Geen restrictie |
|
Marthe Paats |
Longarts Erasmus MC |
geen |
Geen relevant voor huidige richtlijn. |
geen |
industrie gesponsorde studies lopend in het Erasmus MC waarbij ik lokale PI ben. |
geen |
geen |
26-02-2024 |
Geen restrictie. In de richtlijn worden geen systemische therapien aanbevolen. |
|
Robin Boltjes |
Neuroloog in Antoni van Leeuwenhoek/NKI |
geen |
geen |
nee |
geen |
geen |
nee |
22-11-2023 |
Geen restrictie |
|
Ronald Bartels |
Neurochirurg |
Medisch Adviseur |
geen |
nee |
geen |
net |
geen |
03-04-2024 |
Restrictie ten aanzien van besluitvorming betreffende 'Inschatten overleving'. Vanuit expertise wel meegediscussierd over inhoud van de module, niet betrokken bij het formuleren van de aanbevelingen. |
|
Tebbe Sluis |
revalidatiearts |
geen |
geen |
geen |
geen |
geen |
geen |
11-12-2023 |
Geen restrictie |
|
Vivian Bongers |
MSB Domstad, medisch specialist |
Uitgeverij Prelum, Redacteur tijdschrift IMAGO |
Geen |
Geen |
Geen |
Geen |
Geen |
23-11-2023 |
Geen restrictie |
|
Ypma |
internist hematoloog Hagaziekenhuis den Haag |
geen |
geen |
geen |
Alphabet trial |
geen |
nvt |
04-05-2024 |
Geen restrictie |
|
Van Iterson |
AIOS neurologie |
geen |
geen |
geen |
geen |
geen |
geen |
25-04-2024 |
Geen restrictie |
|
Selma Algra |
Radioloog,St Jansdal Ziekenhuis |
geen |
geen |
geen |
geen |
geen |
geen |
03-09-2024 |
Geen resctrictie |
|
Silvie Dronkers |
Stichting Darmkanker |
geen |
geen |
geen |
geen |
geen |
geen |
06-02-2025 |
Geen restrictie |
|
Walter Taal (voorzitter) |
Neuroloog, Erasmus MC, Rotterdam |
Geen |
Geen |
Geen |
Ja. Alleen op het gebied van neurofibromatose type 1 |
Geen |
Geen |
07-06-2023 |
Geen restrictie |
|
Marije Vos-van der Hulst |
Revalidatie arts, Sint Maartenskliniek Nijmegen |
Voorzitter werkgroep revalidatie artsen dwarslaesie (Nederlands Vlaams dwarslaesie genootschap= werkgroep van de vereniging revalidatieartsen nederland (VRA)) |
geen |
geen |
geen |
geen |
geen |
13-10-2025 |
Geen restrictie |
|
Naam KLANKBORDGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Manon Immerzeel |
Deelnemer clusterstuurgroep |
Geen |
Geen |
Geen |
Geen |
Voorzitter in het bestuur van V&VN pijnverpleegkundigen |
Neen |
22-03-2022 |
Geen restrictie |
|
Anita Ophof |
Antoni van Leeuwenhoek Ziekenhuis |
Geen |
Geen |
Geen |
Geen |
Geen |
Geen |
01-05-2025 |
Geen restrictie |
Inbreng patiëntenperspectief
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerde de werkgroep conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
De kwalitatieve raming is toegevoegd aan het einde van elke herziene module.
| Module | Uitkomst raming | Toelichting |
| Combination of surgery and radiotherapy | Geen substantiële financiële gevolgen | Hoewel uit de toetsing volgt dat de aanbevelingen breed toepasbaar zijn (5.000-40.000 patiënten), volgt ook uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft. Er worden daarom geen substantiële financiële gevolgen verwacht. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.
Zoekverantwoording
Algemene informatie
|
Cluster/richtlijn: NVN Wervelmetastasen |
|
|
Uitgangsvraag/modules: UV6 Wat is de optimale volgorde van interventies, eerst opereren of eerst RT? Met het oog op proactief afstemmen van deze behandeling? |
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|
Database(s): Embase.com, Ovid/Medline all |
Datum: 19 mei 2025 |
|
Periode: vanaf 2003 |
Talen: geen restrictie |
|
Literatuurspecialist: Alies Oost |
|
|
BMI-zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ |
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Toelichting: De sleutelartikelen worden gevonden met deze search. “Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial/ Patchell R.A.” (PMID 16112300) valt op dit moment niet binnen het resultaat omdat is besloten om eerst alleen SRs te screenen.
Retracted en daarom uit het resultaat gehaald: Risk factors for postoperative surgical site wound problems after metastatic and primary spine tumour surgery: A meta-analysis/ J. Zhu, M. Si and Z. Huang. International Wound Journal 2023 Vol. 20 Issue 8 Pages 3006-3014. |
|
|
Te gebruiken voor richtlijntekst: A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com and Ovid/Medline all. Both databases were searched from 2003 to May 19th, 2025 for systematic reviews. Systematic searches were completed using a combination of controlled vocabulary and natural language keywords. The overall search strategy was derived from the following primary search concepts: (1) spine metastasis; (2) radiotherapy; (3) surgery. Duplicates were removed using EndNote software. After deduplication a total of 516 records were imported for title/abstract screening. |
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Zoekopbrengst
|
|
EMBASE |
OVID/MEDLINE |
Ontdubbeld |
|
SR |
499 |
220 |
516* |
*in Rayyan
Zoekstrategie
Embase.com
|
No. |
Query |
Results |
|
#1 |
'spine metastasis'/exp OR 'spinal cord metastasis'/exp OR 'cervical lymph node metastasis'/exp OR (('spinal cord tumor'/exp OR 'spine tumor'/exp OR 'spinal cord compression'/exp OR (((spinal* OR medulla*) NEAR/3 (compress* OR impingement OR pinch*)):ti,ab,kw)) AND ('metastasis'/de OR 'bone metastasis'/de OR metasta*:ti,ab,kw OR oligometasta*:ti,ab,kw OR micrometasta*:ti,ab,kw OR (((neoplas* OR carcinoma OR cancer* OR malignan* OR tumor* OR tumour*) NEAR/4 (dissemination OR disseminated OR spread* OR secondary OR migrat* OR seed*)):ti,ab,kw))) OR (((spine* OR spinal* OR intraspinal OR vertebr* OR 'cauda equina' OR cervicothoracic OR cord* OR coccyx OR duralsac* OR 'dural sac*' OR epidural OR extradural OR 'extra dural' OR intervertebr* OR lumbar OR lumbosac* OR 'lumbo sac*' OR orthothoracic OR sacral OR sacrum OR 'thecal sac*' OR thoracolumbar OR odontoid OR 'anterior horn' OR 'posterior horn' OR 'extrapyramidal tract*' OR 'pyramidal tract*' OR 'substantia gelatinosa' OR 'spinothalamic tract*') NEAR/4 (metast* OR oligometast* OR micrometast*)):ti,ab,kw) OR ((cervical*:ti,ab,kw OR medulla*:ti,ab,kw OR intramedulla*:ti,ab,kw OR thoracic:ti,ab,kw) AND (spine*:ti,ab,kw OR spinal*:ti,ab,kw OR intraspinal:ti,ab,kw OR vertebr*:ti,ab,kw OR intervertebr*:ti,ab,kw OR lumbar:ti,ab,kw) AND (metast*:ti,ab,kw OR oligometast*:ti,ab,kw OR micrometast*:ti,ab,kw)) OR mescc:ti,ab,kw OR mscc:ti,ab,kw |
31003 |
|
#2 |
'radiotherapy'/exp OR 'radiosurgery'/exp OR 'radiotherap*':ti,ab,kw OR radiosurg*:ti,ab,kw OR 'radio surg*':ti,ab,kw OR irradiat*:ti,ab,kw OR radiati*:ti,ab,kw OR ((bucky NEAR/2 (radiat* OR ray* OR therap* OR treat*)):ti,ab,kw) OR (((radio* OR radiat* OR roentgen OR rontgen) NEAR/2 (therap* OR treat*)):ti,ab,kw) OR 'x radiotherap*':ti,ab,kw OR 'x ray therap*':ti,ab,kw OR 'x ray treatment*':ti,ab,kw OR ((stereotactic NEAR/3 (radiat* OR radio*)):ti,ab,kw) OR sbrt:ti,ab,kw OR sabr:ti,ab,kw OR sabrt:ti,ab,kw |
1506003 |
|
#3 |
'surgery'/exp OR 'surgical patient'/exp OR 'surgical risk'/exp OR 'perioperative period'/exp OR 'surgery'/lnk OR surgic*:ti,ab,kw OR surger*:ti,ab,kw OR operation*:ti,ab,kw OR operative:ti,ab,kw OR presurg*:ti,ab,kw OR preoperati*:ti,ab,kw OR perisurg*:ti,ab,kw OR perioperati*:ti,ab,kw OR postsurg*:ti,ab,kw OR postoperati*:ti,ab,kw OR nonsurg*:ti,ab,kw OR nonoperatic*:ti,ab,kw OR intraoperati*:ti,ab,kw OR thoracoscop*:ti,ab,kw OR videothoracoscop*:ti,ab,kw OR laparoscop*:ti,ab,kw OR 'mini* invasive':ti,ab,kw OR 'mini* access':ti,ab,kw OR vats:ti,ab,kw OR rats:ti,ab,kw OR robot*:ti,ab,kw OR 'video assisted':ti,ab,kw OR 'videoassisted':ti,ab,kw OR endosurg*:ti,ab,kw OR (((percutaneous OR endoscop* OR arthroscop*) NEAR/3 (surg* OR radiosurg* OR operat* OR procedure* OR fixat* OR rod OR rods OR screw*)):ti,ab,kw) OR 'vertebral augmentation'/exp OR 'vertebral augmentation':ti,ab,kw OR 'kyphoplasty'/exp OR kyphoplast*:ti,ab,kw OR 'percutaneous vertebroplasty'/exp OR vertebroplast*:ti,ab,kw OR 'image guided':ti,ab,kw |
9579627 |
|
#4 |
#1 AND #2 AND #3 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) |
7673 |
|
#5 |
#4 AND [2003-2025]/py |
6793 |
|
#6 |
'meta analysis'/exp OR 'systematic review'/exp OR 'scoping review'/exp OR 'rapid review'/exp OR 'umbrella review'/exp OR 'cochrane database of systematic reviews'/jt OR 'network meta-analysis'/exp OR 'networkmeta analy*':ti,ab,kw OR 'networkmetaanaly*':ti,ab,kw OR metaanaly*:ti,ab,kw OR 'meta analy*':ti,ab,kw OR metanaly*:ti,ab,kw OR prisma:ti,ab,kw OR prospero:ti,ab,kw OR metaanali*:ti,ab,kw OR 'meta anali*':ti,ab,kw OR metanali*:ti,ab,kw OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab,kw) OR (((structured OR systemic*) NEAR/3 (review* OR overview* OR synth*) NEAR/3 literature):ti,ab,kw) OR ((systemic* NEAR/1 review*):ti,ab,kw) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab,kw) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab,kw) OR (((literature NEAR/3 (review* OR overview*)):ti,ab,kw) AND (search*:ti,ab,kw OR database*:ti,ab,kw OR 'data base*':ti,ab,kw)) OR (('data extraction*':ti,ab,kw OR 'data source*':ti,ab,kw) AND ('study selection*':ti,ab,kw OR 'studies selection*':ti,ab,kw)) OR ('search strateg*':ti,ab,kw AND 'selection criteria*':ti,ab,kw) OR ('data source*':ti,ab,kw AND 'data synth*':ti,ab,kw) OR medline*:ti,ab,kw OR pubmed*:ti,ab,kw OR 'pub med*':ti,ab,kw OR embase:ti,ab,kw OR cochrane*:ti,ab,kw OR (((critical* OR rapid*) NEAR/2 (review* OR overview* OR synth*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synth*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynth*:ti,ab,kw OR 'meta synth*':ti,ab,kw OR 'review* of review*':ti,ab,kw |
1114396 |
|
#7 |
#5 AND #6 |
499 |
Ovid/Medline
|
# |
Searches |
Results |
|
1 |
((exp Spinal Neoplasms/ or exp Spinal Cord Neoplasms/ or exp Spinal Cord Compression/ or ((spinal* or medulla*) adj3 (compress* or impingement or pinch*)).ti,ab,kf.) and (exp Neoplasm Metastasis/ or metasta*.ti,ab,kf. or oligometasta*.ti,ab,kf. or micrometasta*.ti,ab,kf. or ((neoplas* or carcinoma or cancer* or malignan* or tumor* or tumour*) adj4 (dissemination or disseminated or spread* or secondary or migrat* or seed*)).ti,ab,kf.)) or ((spine* or spinal* or intraspinal or vertebr* or 'cauda equina' or cervicothoracic or cord* or coccyx or duralsac* or 'dural sac*' or epidural or extradural or 'extra dural' or intervertebr* or lumbar or lumbosac* or 'lumbo sac*' or orthothoracic or sacral or sacrum or 'thecal sac*' or thoracolumbar or odontoid or "Anterior Horn" or "Posterior Horn" or "Extrapyramidal Tract*" or "Pyramidal Tract*" or "Substantia Gelatinosa" or "Spinothalamic Tract*") adj4 (metast* or oligometast* or micrometast*)).ti,ab,kf. or ((cervical* or medulla* or intramedulla* or thoracic) and (spine* or spinal* or intraspinal or vertebr* or intervertebr* or lumbar) and (metast* or oligometast* or micrometast*)).ti,ab,kf. or mescc.ti,ab,kf. or mscc.ti,ab,kf. |
15803 |
|
2 |
exp Radiotherapy/ or 'radiotherap*'.ti,ab,kf. or radiosurg*.ti,ab,kf. or 'radio surg*'.ti,ab,kf. or irradiat*.ti,ab,kf. or radiati*.ti,ab,kf. or (bucky adj2 (radiat* or ray* or therap* or treat*)).ti,ab,kf. or ((radio* or radiat* or roentgen or rontgen) adj2 (therap* or treat*)).ti,ab,kf. or 'x radiotherap*'.ti,ab,kf. or 'x ray therap*'.ti,ab,kf. or 'x ray treatment*'.ti,ab,kf. or (stereotactic adj3 (radiat* or radio*)).ti,ab,kf. or sbrt.ti,ab,kf. or sabr.ti,ab,kf. or sabrt.ti,ab,kf. |
950223 |
|
3 |
exp Surgical Procedures, Operative/ or exp Specialties, Surgical/ or su.fs. or exp Perioperative Period/ or surgic*.ti,ab,kf. or surger*.ti,ab,kf. or operation*.ti,ab,kf. or operative.ti,ab,kf. or presurg*.ti,ab,kf. or preoperati*.ti,ab,kf. or perisurg*.ti,ab,kf. or perioperati*.ti,ab,kf. or postsurg*.ti,ab,kf. or postoperati*.ti,ab,kf. or nonsurg*.ti,ab,kf. or nonoperatic*.ti,ab,kf. or laparoscop*.ti,ab,kf. or thoracoscop*.ti,ab,kf. or videothoracoscop*.ti,ab,kf. or laparoscop*.ti,ab,kf. or 'mini* invasive'.ti,ab,kf. or 'mini* access'.ti,ab,kf. or vats.ti,ab,kf. or rats.ti,ab,kf. or robot*.ti,ab,kf. or 'video assisted'.ti,ab,kf. or 'videoassisted'.ti,ab,kf. or endosurg*.ti,ab,kf. or ((percutaneous or endoscop* or arthroscop*) adj3 (surg* or radiosurg* or operat* or procedure* or fixat* or rod or rods or screw*)).ti,ab,kf. or 'vertebral augmentation'.ti,ab,kf. or exp Kyphoplasty/ or kyphoplast*.ti,ab,kf. or exp Vertebroplasty/ or vertebroplast*.ti,ab,kf. or 'image guided'.ti,ab,kf. |
6872886 |
|
4 |
(1 and 2 and 3) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) |
3885 |
|
5 |
limit 4 to yr="2003 -Current" |
3183 |
|
6 |
exp Meta-Analysis/ or exp Network Meta-Analysis/ or exp Systematic Review/ or (networkmeta analy* or networkmetaanaly* or metaanaly* or meta analy* or metanaly* or prisma or prospero or metaanali* or meta anali* or metanali*).ti,ab,kf. or ((systemati* or scoping or umbrella or structured literature) adj3 (review* or overview*)).ti,ab,kf. or ((structured or systemic*) adj3 (review* or overview* or synth*) adj3 literature).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 (review* or overview*)) and (search* or database* or data base*)).ti,ab,kf. or ((data extraction* or data source*) and (study selection* or studies selection*)).ti,ab,kf. or (search strateg* and selection criteria*).ti,ab,kf. or (data source* and data synth*).ti,ab,kf. or (medline* or pubmed* or pub med* or embase or cochrane*).ti,ab,kf. or cochrane.jw. or ((critical* or rapid*) adj2 (review* or overview* or synth*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synth*)) and (search* or database* or data base*)).ab. or metasynth*.ti,ab,kf. or meta synth*.ti,ab,kf. |
833048 |
|
7 |
5 and 6 |
220 |