Systematic Review of the Diagnosis and Management of Malignant Extradural Spinal Cord Compression: The Cancer Care Ontario Practice Guidelines Initiative‘s Neuro-Oncology Disease Site Group

Loblaw, D. Andrew; Perry, James; Chambers, Alexandra; Laperrière, Normand

doi:10.1200/jco.2005.00.067

Cited by 289 publications

(183 citation statements)

References 52 publications

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“…Despite the fact that IMSCC is often denoted as 'sub-clinical' cord compression, all of the IMSCC patients for whom we have pain data with reported pain at presentation, with a significant proportion (62%) reporting severe pain (scores [8][9][10]. This illustrates the clinical importance of the IMSCC event.…”

Section: Clinical Symptomsmentioning

confidence: 83%

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A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone

et al. 2013

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A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone Purpose: To record the characteristics, management and functional outcome of a group of patients with IMSCC, who were treated with radiotherapy in our institution, and compare these parameters with similar data on MSCC patients.Materials and methods: Data (gender, age, primary oncological diagnosis, pain, performance status and neurological status) were prospectively collected for 28 patients. Patients were then followed up post treatment to document their response to treatment and treatment-related toxicity.Results: The median survival of our group of IMSCC patients is similar to that of an MSCC patient. In addition, the IMSCC group exhibits significant clinical symptoms including neurological deficit. Conclusion:Although further studies are necessary, we have found that IMSCC patients in this study share similar prognosis and clinical symptoms with MSCC patients. Clinicians should be aware of this when communicating with IMSCC patients and their families, and short-course radiotherapy should be considered.

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Section: Clinical Symptomsmentioning

confidence: 83%

“…Much data have been published regarding the natural history and outcomes in the treatment of MSCC, [9][10][11][12][13][14] allowing an evidence-based approach to clinical investigation and treatment. There is also a clear consensus that an urgent approach is necessary when providing treatment for these patients.…”

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confidence: 99%

A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone

et al. 2013

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“…Many surgeons would consider bony compression causing an SCC, spinal instability, recompression in an irradiated region and neurologic deterioration during a course of radiotherapy as indications for surgical intervention. 9 In the clinical setting of malignant SCC of unknown primary, surgery would also provide histologic confirmation of the primary tumour in addition to being therapeutic. Although there is no consensus on the optimal management of malignant SCC, a potentially aggressive intervention associated with long hospitalization and recovery in what is usually a palliative situation associated with limited survival 10 must be weighed against individual patients' clinical status and prognosis.…”

Section: Discussionmentioning

confidence: 99%

Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance

Yee¹,

Gabos

North³

et al. 2012

CUAJ

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We report cases of 2 pure seminoma patients who developed metastatic spinalcord compressions. One patient was diagnosed at age 33 years with stage 1seminoma and, after undergoing an orchidectomy, chose to be followed ona surveillance protocol. He was lost to follow-up and presented again 22months later with back pain, leg weakness and sensory loss when his diseaserecurred as a spinal cord compression. He was treated with urgent surgicaldecompression and subsequent standard chemotherapy. More than 2years posttreatment, he is disease-free with normal neurologic function inhis lower extremities. The second patient presented at age 44 years withback pain and rapid loss of leg strength and sensation. Investigations revealeda malignant cord compression with lymphatic and vertebral body metastases.On physical examination, the patient was found to have a 6-cm lefttesticular mass. He was treated with emergency radiotherapy to the regionof his cord compression followed by a left inguinal orchidectomy. Pathologyconfirmed a pure classic seminoma. Postoperatively, he received standardchemotherapy and eventually regained neurologic function in his legs. Althoughit is rare for malignant spinal cord compression to occur in seminoma patients—either as the initial presentation of disease or as a site of disease recurrencein stage 1 patients on surveillance—it is crucial to consider seminoma as apossible etiology in young men diagnosed with malignant spinal cord compressionbecause timely contemporary treatments for seminoma will cure mostof these patients and offer them excellent functional recovery.

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“…On the other hand, role of systemic corticosteroids in the management of malignant spinal cord 9 compression were also reported, 20 corticosteroids may be needed when EBRT to the skull base metastasis from PCa is performed. On the basis of these results, EBRT with 40 -50 Gy in 20 -25 fractions to the skull base metastasis in association with corticosteroid administration may be a reasonable treatment modality for maintenance of focal control of cranial nerve deficit and prevention of late onset toxicities in Japanese CRPC patients.…”

Section: Discussionmentioning

confidence: 99%

Cranial nerve deficit caused by skull metastasis of prostate cancer: three Japanese castration-resistant prostate cancer cases

et al. 2010

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We report 3 Japanese patients with cranial nerve deficit caused by skull metastasis of prostate cancer (PCa). Case 1 was a 75-year-old patient with a chief complaint of diplopia. The cause of diplopia was right oculomotor nerve palsy from the skull metastasis. External beam radiation therapy (EBRT) to the whole brain, 40 Gy in 20 fractions, was performed and the diplopia improved. Case 2 was a 72-year-old patient with a chief complaint of facioplegia. Bone scintigraphy and computed tomography (CT) of the head revealed right occipital bone metastasis of PCa resulting in right facial nerve palsy. EBRT to the right occipital bone, 50 Gy in 25 fractions, with daily oral dexamethasone (DEX) was performed and facioplegia showed complete recovery.At 12 months after onset, the patient was followed with no symptoms. Case 3 was a 74-year-old patient with a chief complaint of diplopia. Diffusion weighted magnetic resonance imaging (MRI) and positron emission tomography (PET) showed right petrous bone metastasis resulting in right abducent nerve palsy. EBRT to the right petrous bone, 44 Gy in 22 fractions, with oral DEX was performed and diplopia showed complete recovery. At 13 months after onset, the patient was followed with no symptoms. MRI and PET may detect PCa metastasis in the skull base more clearly than other imaging modalities. EBRT with 40 -50 Gy in 20 -25 fractions in association with corticosteroid administration may be a reasonable treatment modality in the treatment of patients with metastatic PCa who develop cranial nerve dysfunction.

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Systematic Review of the Diagnosis and Management of Malignant Extradural Spinal Cord Compression: The Cancer Care Ontario Practice Guidelines Initiative‘s Neuro-Oncology Disease Site Group

Cited by 289 publications

References 52 publications

A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone

A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone

Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance

Cranial nerve deficit caused by skull metastasis of prostate cancer: three Japanese castration-resistant prostate cancer cases

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