A case of long-term survival after multimodal local treatments of intramedullary spinal cord metastasis of squamous cell lung cancer

Abstract

Intramedullary spinal cord metastasis of non-small cell lung cancer is rare, and it has a short prognosis. We report a 53-year-old man diagnosed with cT4N0M0, stage IIIA squamous cell lung cancer.Ten months after left pneumonectomy (pT4N0M0), an intramedullary spinal cord tumor developed at the axis level. The intramedullary spinal cord tumor was resected, and he was diagnosed with metastatic squamous cell lung cancer. Radiotherapies and another tumor resection were conducted, as he had a good performance status and the discrete lesion was associated with the risk of brain stem compression.Multimodal local treatments for intramedullary spinal cord metastasis caused the tumor to shrink, and he lived for 25 months after the spinal metastasis occurred. After 25 months from the metastatic diagnosis, he died of respiratory arrest due to brain stem compression. Keywords DiscussionThe present patient's clinical course suggests two important clinical issues. First, metastatic squamous cell lung cancer of the intramedullary spinal cord can be detected in patients with a good performance status. However, it can be overlooked because of the following reasons. Intramedullary spinal cord metastasis of lung cancer is rare with an incidence rate of 1.65% and that of squamous cell lung cancer is especially rare at 0.16% on autopsy (1). The prognosis of intramedullary spinal cord metastasis of non-small cell lung cancer is short at approximately 5 months (2) and 23.5 months at the longest (3). Lastly, the neurologic symptoms are often confused with brain metastasis, meningitis carcinomatosa, or the side effects of chemotherapy (4). Thus, clinicians should perform brain and spinal cord MRI when they observe neurological deficits during the clinical course of lung cancer. improve survival (5,6), and radiotherapy may contribute to improving survival (3,7,8). We performed multimodal local therapies because our patient had a good performance status and local recurrence with the risk of brain stem compression. Therefore, surgery, radiotherapy, or a combination of both should be performed whenever feasible. Chemotherapy may be effective for intramedullary spinal cord metastases of small cell lung cancer (9), and tyrosine kinase inhibitors (TKI) may be effective against metastases originating from TKI-sensitive adenocarcinoma (10,11). Chemotherapy can be poorly effective for intramedullary metastases with low drug permeability due to the blood-spinal cord barrier (12). In our case, chemotherapies were ineffective even after surgeries that were supposed to break the blood-spinal cord barrier. Treatment of intramedullary metastases may be related to drug permeability and the nature of the chemoresistance of squamous cell lung cancer. Yet, despite the neurological complication, surgical and radiological treatment reduced the tumor size and improved the patient's survival. ConclusionsThis is a rare case of squamous cell lung cancer metastasizing to the intramedullary spinal cord, and our patient survived longer with multimodal l...

<p>Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review</p>

“…Multimodal local intervention including surgery and irradiation might attain survival benefit. Minomo et al26 reported an ISCM patient of squamous cell lung cancer who experienced repeated recurrences, surgery, and radiotherapy twice contributed a long-term survival of 25 months.…”

A Rarely Seen Pathology "Intramedullary Spinal Metastasis"; Clinical Series of Five Patients in a Single Institution

“…After full-text evaluation, they were arranged according to the year of publication. Finally, a total of 16 research articles, including the aforementioned search terms, were included in the present study (10,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29).…”

“…Lung cancer is the most common (54%) ISCM-causing tumor, and small cell lung cancer is the most common subtype. Other than this, ISCMs may be seen in breast cancer (13%), renal cancer (4%), melanomas (9%), and/ or lymphomas (5%) (6)(7)(8)(9)(10).…”

Intramedullary Spinal Cord Metastases from Differentiated Thyroid Cancer, a Case Report

“…In half of the cases, lung cancer is the most common ISCM-related tumor and small cell lung cancer is the most common subtype. Other than this, ISCM may be seen in breast cancer (13%), renal cancer (4%), melanomas (9%), and/or lymphomas (5%) [ 7 , 8 , 9 , 10 , 11 ]. In metastatic spinal tumors, the age of diagnosis is frequently from 50 to 60 years.…”