Metastatic Spinal Cord Compression and Steroid Treatment

Abstract

Study Design: Systematic review. Objectives: We conducted a systematic review of the literature to answer the following questions regarding the use of steroid therapy in metastatic spinal cord compression (MSCC): 1. In cases of MSCC, what is the effect of steroid administration before definitive radiotherapy or surgery on ambulatory status, bowel and bladder function and survival? 2. What steroid dosing regimens are associated with the best outcomes concerning neurological symptoms and complication prevention in cases of MSCC? Summary of Background Data: Currently, there is significant variation in the initial bolus dose, daily maintenance dose and duration of treatment when steroids are used as a bridge to definitive therapy for MSCC. Methods: A literature search following PRISMA guidelines was conducted in June 2016, using Medline via Ovid SP, Medline via PubMed, Embase, Biosis Previews and the Cochrane Library. Search terms used in each database varied slightly to optimize results. All generic steroid formulations were included along with spinal cord compression or myelopathy combined with metastatic or malignant tumors. Papers discussing acute traumatic causes of spinal cord compression were excluded, as were papers discussing cord compression from nonmetastatic tumors or epidural lipomatosis. Subjects were limited to adult humans undergoing definitive treatment with radiotherapy or surgery. Results: Of the 309 papers retrieved, 66 full text studies were reviewed and 6 papers were found to address the stated questions. Conclusions: There is a paucity of high quality literature evaluating the use of steroids in MSCC. On the basis of the evidence available an initial 10 mg intravenous bolus of dexamethasone followed by 16 mg PO QD has been associated with fewer complications compared with 100 mg bolus and 96 mg QD. Weaning of steroids should occur rapidly after definitive treatment. Risk of gastric bleeding or perforation can be managed with the routine use of proton-pump inhibitors. Level of Evidence: Level IIIa.

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

“…Corticosteroids are also a mainstay of treatment of spinal metastases and are thought to help alleviate vasogenic edema and decrease inflammation, which is especially beneficial in metastases producing spinal cord compression (7). Moreover, steroids may have a direct cytotoxic effect on certain hematological malignancies (myeloma and lymphoma) and, at times, breast cancer (5,6).…”

“…Exact guidelines for using steroids for spinal metastases have not been established; dosing is generally decided on an ad hoc basis. Past trials have advocated both for using the minimal dose of steroids possible as well as treating with high-dose steroids (particularly when treatment also involves RT) (5,7). Transient improvements in ambulation may be seen after initiating steroids and some patients may remain on steroids long-term to reduce pain (6,7).…”

Intercorrências onco-hematológicas

“…A atual recomendação é de regime de alta dose para pacientes que apresentam paraplegia, com redução pela metade a cada três dias. Pacientes com dor e disfunção neurológica mínima devem utilizar bolus de 10 mg de glicocorticoide, seguido por doses diárias de 16 mg. Depois da instalação do tratamento definitivo, pode-se diminuir gradualmente a dose (KUMAR; WEBER; GOKASLAN; WOLINSKY; SCHMIDT;RHINES et al, 2017).…”

Kompresi Medulla Spinalis akibat Metastasis

“…7 Jenis obat yang diberikan biasanya deksametason intravena. 9 Dengan dosis awal yang dikatakan cukup efektif untuk terapi KMSM tanpa risiko efek samping yaitu 10 mg bolus intravena dilanjutkan 4 mg tiap 6 jam. Tapering-off steroid paling sering dilakukan setelah radiasi atau setelah terlihat perbaikan status neurologis.…”