Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance

White, Barrie; Stirling, Allan; Paterson, E; Asquith-Coe, K; Melder, Angela

doi:10.1136/bmj.a2538

Cited by 53 publications

(34 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, patients with marginal recurrences had poorer prescription coverage of the GTV (86% vs 93%, PZ.01) compared with those with in-field recurrences, potentially because of more upfront spinal canal disease (78% vs 24%, PZ.001). Using a Cox regression univariate analysis, patients with a GTV BED Dmin 33.4 Gy (median dose) (equivalent to 14 Gy in 1 fraction) had a significantly higher 1-year LC rate (94% vs 80%, PZ.001) compared with patients with a lower GTV BED Dmin; this factor was the only Introduction Spine metastases occur in 3% to 5% of all patients with a cancer diagnosis and have an incidence as high as 19% among certain histologies (1,2). Management has typically consisted of palliative surgery or radiation therapy (RT) to aid in preventing cases of spinal cord or root compression.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

Bishop

Tao

Rebueno

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

102

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

Bishop

Tao

Rebueno

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

102

View full text Add to dashboard Cite

“…Even without "red flag" signs, a full neurological examination should be done in these patients, with a low threshold for a spinal magnetic resonance scan. 7 Even if suspicion is low, advice should be sought from the patient's oncologist; retrospective cohort studies have shown that being able to walk at the time of diagnosis of spinal cord compression is correlated with overall survival and the ability to walk after treatment. Early diagnosis and treatment of impending spinal cord compression can drastically improve quality of life for patients.…”

Section: Sources and Selection Criteriamentioning

confidence: 99%

Cancer induced bone pain

Kane

Hoskin

Bennett

2015

BMJ

101

View full text Add to dashboard Cite

What to discuss with patients who are starting strong opioidsAddress concerns about addiction, tolerance, and side effects, being clear that prescription of strong opioids does not mean patients are in the last stage of life Give verbal and written advice on when and how to take opioids for both background and breakthrough pain Explain how long the pain relief should last and that patients ability to drive may be impaired during initiation of treatment or when doses are increasedGive advice on signs of toxicity, such as drowsiness, twitching, and hallucinations, and who to contact if any occur out of hours Provide drugs at the start of treatment, to deal with side effects such as constipation Offer regular review Adapted from NICE clinical guideline 140 (http://guidance.nice.org.uk/CG140) bisphosphonates are equally appropriate and effective interventions.A Cochrane review from 2002 examined the effects of bisphosphonates on cancer induced bone pain and calculated numbers needed to treat of 11 at four weeks after infusion and 7 at 12 weeks after infusion. 31 This review concluded that although evidence supports the use of bisphosphonates they should not be considered as first line management, which is in keeping with the advice from NICE. 31In patients with cancer induced bone pain from myeloma, a Cochrane review showed benefit from bisphosphonates in pain management. 32 DenosumabDenosumab is a novel agent that specifically inhibits RANK-ligand. Clinical trials have shown important benefits in reducing skeletal related events. One randomised controlled trial recruited patients with breast cancer with mild levels of pain. The median time for moderate or severe pain to develop in those receiving denosumab was significantly delayed when compared with bisphosphonate zolendronic acid, although there was no difference in the use of strong analgesics at the end of the study. 33 Interventional proceduresIf patients have ongoing complex cancer induced bone pain despite receiving opioids, radiotherapy, or bisphosphonates, referral to pain services should be considered. There is good evidence from a randomised controlled trial that implantable intrathecal devices lead to a reduction in pain and increased survival in patients taking high dose opiates for refractory pain. SurgeryIn patients with a good performance status, prophylactic surgery may be considered for relief of cancer induced bone pain. One randomised controlled trial showed that percutaneous stabilisation in the long bones of leg can significantly reduce pain. Once a pathological fracture has occurred, however, orthopaedic intervention can stabilise the fracture. Complementary therapiesComplementary therapies may be considered, but as yet they are supported by weak evidence. A Cochrane systematic review of acupuncture acknowledged that there were studies showing benefit in cancer pain, but that evidence was insufficient to recommend this as a treatment. Evidence was also insufficient to support TENS (transcutaneous electrical nerve stimulation), but one small ...

show abstract

“…Although the median overall survival in our study well exceeded the recommended life expectancy limit of 3 or 6 months for surgical treatment of MSCC (White et al. 2008, George et al. 2015), it varied widely according to the type of the primary tumor.…”

Section: Discussionmentioning

confidence: 99%

Metastatic spinal cord compression as the first sign of malignancy

et al. 2017

View full text Add to dashboard Cite

Background and purposeMetastatic spinal cord compression (MSCC) as the initial manifestation of malignancy (IMM) limits the time for diagnostic workup; most often, treatment is required before the final primary tumor diagnosis. We evaluated neurological outcome, complications, survival, and the manner of diagnosing the primary tumor in patients who were operated for MSCC as the IMM.Patients and methodsRecords of 69 consecutive patients (51 men) who underwent surgery for MSCC as the IMM were reviewed. The patients had no history of cancer when they presented with pain (n = 2) and/or neurological symptoms (n = 67).ResultsThe primary tumor was identified in 59 patients. In 10 patients, no specific diagnosis could be established, and they were therefore defined as having cancer of unknown primary tumor (CUP). At the end of the study, 16 patients were still alive (median follow-up 2.5 years). The overall survival time was 20 months. Patients with CUP had the shortest survival (3.5 months) whereas patients with prostate cancer (6 years) and myeloma (5 years) had the longest survival. 20 of the 39 patients who were non-ambulatory preoperatively regained walking ability, and 29 of the 30 ambulatory patients preoperatively retained their walking ability 1 month postoperatively. 15 of the 69 patients suffered from a total of 20 complications within 1 month postoperatively.InterpretationPostoperative survival with MSCC as the IMM depends on the type of primary tumor. Surgery in these patients maintains and improves ambulatory function.

show abstract

Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance

Cited by 53 publications

References 3 publications

Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

Cancer induced bone pain

Metastatic spinal cord compression as the first sign of malignancy

Contact Info

Product

Resources

About