Interventions for the treatment of metastatic extradural spinal cord compression in adults

Abstract

Based on current evidence, ambulant adults with MESCC with stable spines and predicted survival of less than six months will probably benefit as much from one dose of radiation (8 Gy) as from two doses (16 Gy) or eight doses (30 Gy). We are unsure if a single dose is as effective as two or more doses in preventing local tumour recurrence. Laminectomy preceding radiotherapy may offer no benefits over radiotherapy alone. Decompressive surgery followed by radiotherapy may benefit ambulant and non-ambulant adults younger than 65 years of age, with poor prognostic factors for radiotherapy, a single area of compression, paraplegia for less than 48 hours, and a predicted survival of more than six months. We are uncertain whether high doses of corticosteroids offer any benefits over moderate doses or indeed no corticosteroids; but high-dose steroids probably significantly increases the risk of serious adverse effects. Early detection; and treatment based on neurological status, age and estimated survival, are crucial with all treatment modalities. Most of the evidence was of low quality. High-quality evidence from more trials is needed to clarify current uncertainties, and some studies are in progress.

An Atypical Initial Presentation of Hepatocellular Carcinoma as Spinal Cord Compression

“…This was demonstrated by the SHARP trial in the region with a higher prevalence of those identical to our patient who was a non-cirrhotic with HCC due to Hepatitis B. Spinal cord compression as a complication of metastatic carcinoma requires prompt diagnosis and urgent surgical decompression, which can significantly change the clinical course [13]. Clinical trials have shown that decompressive surgery has shown the best chance for recovery and future ambulation [14].…”

Radiation Oncology

“…Initial treatment is with glucocorticoids, typically dexamethasone at doses of 16 mg daily, with opiate-based analgesia. A Cochrane meta-analysis of three trials of differing dose levels was unable to determine clinical benefi t and optimal dosage [ 37 ], with higher doses associated with serious toxicities [ 38 ].…”

Early Intervention Results in Lower Mortality in Patients with Cancer Hospitalized for Metastatic Spinal Cord Compression

“…Dexamethasone is often used in the acute setting to help alleviate vasogenic edema 20 21. Subsequent surgical decompression and radiotherapy (RT) are based on a careful assessment of the stability of the spine by spine surgeons and radiation oncologists.…”