The clinical findings in 130 conseucutive cases of spinal cord compression by metastatic extradural tumors were analyzed. These 130 patients were combined with a previous survey of 105 patients to compare the effectiveness of radiation therapy (RT) alone with that of surgical decompression followed by RT. Ambulation after treatment was considered a successful outcome. The most common primary tumors producing spinal cord compression were (in order) breast, lung, prostate, and kidney. In 68% of these tumors the thoracic region was involved. Pain was the primary symptom of 96% of the patients, while motor or sensory deficits (or both) were found in 82% of them. Therapy consisted of surgery and RT in 65 patients and RT alone in 170 patients. There were no differences in outcome between those treated by surgery combined with RT and those managed by RT alone. Patients with radiosensitive tumors and those ambulatory at the onset of treatment benefited whether treated by surgery or by RT. Seventy-five percent of living patients who improved from treatment remained ambulatory at 6 months, and approximately 50% of living patients were ambulatory at 1 year. We conclude that RT without decompressive laminectomy is as effective as decompressive laminectomy in treating epidural spinal cord compression from systemic cancer.
We believe that the tool can spur useful dialogue among researchers and increase in-depth understanding of reviewed papers, including the strengths and limitations of the literature. To increase the clarity of the process, we suggest further definition of the language in each indicator and inclusion of explicit examples for each criterion. We would also like to see the authors outline clear parameters around the use of the tool, essentially stating that the tool should be used in synthesis work for studies of mixed methods or work that includes qualitative and quantitative research informed by a positivist paradigm. In the context of an appropriate team composition, the tool can be a useful mechanism for guiding people who are coming together to discuss the merits of studies across multiple methodologies and disciplines.
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