Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression

Heldmann, U.; Myschetzky, Peter Sand; Thomsen, Henrik S.

doi:10.1080/02841859709172086

Cited by 27 publications

(12 citation statements)

References 10 publications

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“…The cervical spine is involved in <10% of patients, the thoracic spine in 60-80%, and the lumbar spine in 15-30%. [4][5][6][7] Despite improved treat ment approaches regarding surgical intervention and modern radiation techniques, the treatment of MESCC remains challenging. In this Review, we discuss the role of radiotherapy in the treatment of MESCC.…”

Section: Introductionmentioning

confidence: 99%

The role of radiotherapy for metastatic epidural spinal cord compression

2010

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Radiotherapy alone is the most common treatment for metastatic epidural spinal cord compression (MESCC). Decompressive surgery followed by radiotherapy is generally indicated only in 10-15% of MESCC cases. Chemotherapy has an unclear role and may be considered for selected patients with hematological or germ-cell malignancies. If radiotherapy alone is given, it is important to select the appropriate regimen. Similar functional outcomes can be achieved with short-course radiotherapy regimens and longer-course radiotherapy regimens. Longer-course radiotherapy is associated with better local control of MESCC than short-course radiotherapy. Patients with a more favorable survival prognosis (expected survival of ≥6 months) should receive longer-course radiotherapy, as they may live long enough to develop a recurrence of MESCC. Patients with an expected survival of <6 months should be considered for short-course radiotherapy. A recurrence of MESCC in the previously irradiated region after short-course radiotherapy may be treated with another short-course of radiotherapy. After primary administration of longer-course radiotherapy, decompressive surgery should be performed if indicated. Alternatively, re-irradiation can be performed using high-precision techniques to reduce the cumulative dose received by the spinal cord. Larger prospective trials are required to better define the appropriate treatment for the individual patient.

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Section: Introductionmentioning

confidence: 99%

The role of radiotherapy for metastatic epidural spinal cord compression

2010

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“…Further estimates conclude that 5–10% of cancer patients will develop spinal metastasis [3]. In cancer patients with acute onset of back pain or other clinical suspicion for spinal metastatic disease, rates of spinal metastasis exceeding 25% have been reported [3, 4]. Radiotherapy has long been established as an effective treatment modality for spinal tumors [5–8].…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiosurgery for Spinal Metastatic Disease: An Evidence-Based Review

Hall

Stapleford

Hadjipanayis

et al. 2011

International Journal of Surgical Oncology

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Spinal metastasis is a problem that afflicts many cancer patients. Traditionally, conventional fractionated radiation therapy and/or surgery have been the most common approaches for managing such patients. Through technical advances in radiotherapy, high dose radiation with extremely steep drop off can now be delivered to a limited target volume along the spine under image-guidance with very high precision. This procedure, known as stereotactic body radiosurgery, provides a technique to rapidly treat selected spinal metastasis patients with single- or limited-fraction treatments that have similar to superior efficacies compared with more established approaches. This review describes current treatment systems in use to deliver stereotactic body radiosurgery as well as results of some of the larger case series from a number of institutions that report outcomes of patients treated for spinal metastatic disease. These series include nearly 1400 patients and report a cumulative local control rate of 90% with myelopathy risk that is significantly less than 1%. Based on this comprehensive review of the literature, we believe that stereotactic body radiosurgery is an established treatment modality for patients with spinal metastatic disease that is both safe and highly effective.

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“…Multiple epidural metastases has been reported in approximately 30% of patients in myelographic series [6,7] and as many as 49% in MRI series [7,8]. Thus, by not performing complete spinal imaging, additional areas of metastases may be missed.…”

Section: Imagingmentioning

confidence: 93%

Epidural spinal cord compression

Cavaliere

Schiff

2004

Curr Treat Options Neurol

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Epidural spinal cord compression is a neurologic emergency requiring immediate attention. The therapy instituted depends on several factors, including the patient's condition at the time of presentation, the nature of the underlying malignancy, the extent of systemic disease burden, and patient prognosis. The most essential aspect of treatment is the establishment of the diagnosis. If one suspects malignant cord compression an emergency, magnetic resonance imaging of the entire spinal axis is indicated. If magnetic resonance imaging is unavailable, post-myelographic computed tomography is an alternative. However, treatment should not be delayed until imaging is performed, particularly if neurologic deficits are present. Pain should be adequately addressed and opioids administered if necessary. Steroids should be given. If significant neurologic deficits are present, a high-dose corticosteroid bolus, followed by standing doses, should be given. However, if pain is the predominant symptom, steroids can be withheld pending immediate imaging or lower doses can be given without a bolus. Neurosurgical consultation should be obtained, and surgery should be considered if the patient's condition permits. This is particularly true if spinal instability or significant kyphosis is present or compression is secondary to bony fragments. Other indications include patients with limited systemic disease burden in whom better survival is predicted and possibly those with radioresistant tumors. The type of surgery performed should be tailored to the distribution of disease within the spine and accessibility through anterior body cavities. Radiation therapy, an effective noninvasive treatment that can be delivered quickly and safely, is an appropriate option as well. This is particularly true in radio-responsive tumors, such as myeloma and lymphoma, in which surgery may be avoided entirely. Chemotherapy may play a role as adjuvant therapy in some tumors.

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Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression

Abstract: MR accurately demonstrates the anatomy of the spine and spinal cord, showing the level and complexity of spinal lesions. Multiple lesions may be underestimated when the combination of myelography/radiculography and CT is used.

Cited by 27 publications

References 10 publications

The role of radiotherapy for metastatic epidural spinal cord compression

The role of radiotherapy for metastatic epidural spinal cord compression

Stereotactic Body Radiosurgery for Spinal Metastatic Disease: An Evidence-Based Review

Epidural spinal cord compression

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