Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients

Abstract

One hundred thirty consecutive patients with metastatic spinal cord compression (MSCC) were entered in a therapeutic protocol in which radiation therapy (RT) played the main role. When MSCC is diagnosed by clinical-radiologic methods such as myelography with or without computed tomography (CT) or magnetic resonance imaging (MRI), steroids are given and RT treatment started within 24 hours. When diagnostic doubts exist or stabilization is necessary, surgery precedes RT. Chemohormonal potentially responsive tumors are also treated with chemotherapy or hormonal therapy. Twelve patients (9.2%) underwent surgery plus RT, and 118 (90.8%) received RT alone. Thirteen (11%) early death patients were not evaluable. The 105 evaluable cases that received RT alone were analyzed. Median follow-up was 15 months (range, 4 to 38 months). Response among patients with back pain was 80%. In cases with motor dysfunction, 48.6% improved, and in 33 of 105 patients (31.4%) without motor disability there was no deterioration. Forty percent of patients with autonomic dysfunction responded to RT. Median survival time was 7 months with a 36% probability of survival for 1 year. The median duration of improvement was 8 months. The most important prognostic factor was early diagnosis. Radiosensitivity of tumor was only important in paraparetic patients in predicting response to RT. Complete myelographic block significantly diminished response to RT. Vertebral collapse did not influence response or survival.

Untitled

“…One of the largest reports is by Maranzano and colleagues. 51,56,57 They treated 209 patients with radiation (30 Gy) and steroid drugs. Pain was present in 98% of patients and 65% had some degree of neurological dysfunction.…”

“…Loading doses range from 10 to 100 mg, followed by 4 to 24 mg four times a day, tapering down over several weeks. A good evidence (Class I) to support the recommendation that the maneuver be specifically considered as an intervention for the condition B fair evidence (Class II) to support the recommendation that the maneuver be specifically considered as an intervention for the condition C poor evidence (Class III) to support the recommendation that the maneuver be specifically considered as an intervention for the condition or that it confers no advantage over competing interventions* D fair evidence (Class II) to support the recommendation that the maneuver be excluded from consideration as an intervention for the condition E good evidence (Class I) to support the recommendation that the maneuver be excluded from consideration as an intervention for the condition 57,64,78 Many practitioners use the larger doses for patients who present with severe baseline symptoms or worsening neurological examination. Some advocate using the trauma dose protocol in patients with rapid neurological deterioration.…”

Treating Adult Cancer Pain in Primary Care

“…If confirmed, there is good evidence for a loading dose of 96 mg of dexamethasone, then 96 mg per day (divided into 4 doses) for 3 days, tapered off over 10 days, but there is a high risk of serious complications [SORT B]. [25][26][27][28][29] There is lower risk but less effectiveness data for a regimen of 16 mg/day (divided into 4 doses), tapered off over 14 days [SORT C].…”

Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

“…4,19,20,42 Unfortunately, radioresistant histologies demonstrated less than favorable responses 22,33 with a significant subset of patients deriving little palliative benefit or tumor control from this modality alone. 24,35 In subsequent years, a better understanding of spinal biomechanics and the development of internal spinal fixation revitalized the role of surgery in the management of spinal metastasis, resulting in improved functional outcomes and local control. A randomized controlled trial 32 demonstrated the superiority of circumferential decompression and stabilization surgery followed by cEBRT in the maintenance and recovery of ambulation, preservation of continence, pain control, and maintenance or restoration of functional performance, compared with cEBRT alone.…”