Clinical outcome in patients with intramedullary spinal cord metastases from lung cancer

Abstract

Intramedullary spinal cord metastases (ISCM) are uncommon and present with rapidly progressing neurological deficits. The objective of this study was to determine the rate, duration of neurological response and survival after radiation therapy. We have retrospectively reviewed the clinical outcome of six cases with a diagnosis of ISCM from primary lung cancer, non-small cell (NSCLC) (n=3) and small cell (SCLC) (n=3). Total radiation dose ranged from 27 Gy/5 fr to 40 Gy/20 fr. Ambulation was preserved in 3 patients and partially recovered in one. Five out of the six patients (83%) showed improvement in neurological signs/symptoms with a mean duration of 17.2 days (max: 40 days; min: 6 days). Median survival time was 5 months (confidence interval (CI) 95%: 0-12) for NSCLC and 5 months (CI 95%: 4-6) for SCLC. Although radiation response rate is high, the interval free of neurological progression is very short. A therapeutic approach should be considered for each individual.

“Drop metastasis”: a rare diagnosis. A case report and review of literature

“…This case of "drop metastasis" is consistent with the reported literature as to the tumour topography; however most of the reported cases in lung cancer are in small cell lung carcinomas 1,4 this entity is considered a rare event in non-small cell carcinoma of the lung. 2,7 The clinical picture will depend on the spinal level affected; in the literature the cervical cord is the most common site and a possible explanation may be its greater bulk and richer vascular supply.…”

“…3 The diagnosis of "drop metastasis" synchronous with the initial diagnosis is not usual; the reported percentage is 22.5% to 39%. 4,8 In the case reported, the time from clinical presentation of "drop metastasis" until diagnosis was 5 months, significantly longer than the 28 days described in literature. 2,3,4,8 This may be due to the fact that the patient had concomitant osseous metastasis that were misinterpreted as the cause of pain.…”

“…2,7 The clinical picture will depend on the spinal level affected; in the literature the cervical cord is the most common site and a possible explanation may be its greater bulk and richer vascular supply. 3,4,5,6 The diagnosis of "drop metastasis" is a difficult one if based only on the primary tumour. 6 The clues that may help in differentiating between "drop metastasis" versus vertebral metastases are the presence of a rapid progressive neurological deficit associated with pain.…”

“…As clinicians and medical oncologists we should consider the issues that will be raised by the need of diagnosing and managing these patients. 4 We report a case of "drop metastasis" diagnosed by MRI in a patient with advanced small cell lung cancer.…”

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

“…Intramedullary spinal cord metastasis of non-small cell lung cancer is rare, and it has a short prognosis (1)(2)(3). As its clinical symptoms can be confused with other causes (4), brain and spinal cord magnetic resonance imaging (MRI) should be performed when neurological symptoms occur in patients with lung cancer.…”