Treatment of spinal cord tumors

Abstract

Tumors associated with the spinal cord can have devastating effects on patient function and quality of life. Most of these tumors are from metastatic disease, usually to the epidural space. Less frequently, the tumors are intrinsic to the spinal cord itself (ie, primary tumor). Regardless of the etiology, spinal cord tumors often present first with progressive local or radicular pain, or both. Other symptoms include weakness, sensory changes, or sphincter dysfunction. The timeliness of diagnosis of spinal cord tumors and promptness of treatment are important, as they directly affect outcome. Dexamethasone, a corticosteroid, is used as a temporizing measure to improve or stabilize neurologic function until definitive treatment. For nonambulatory patients with epidural metastatic tumors, surgery followed by radiation therapy maximizes neurologic function and modestly lengthens survival. However, palliative radiotherapy alone is recommended for those with neurologic deficits lasting longer than 48 hours, survival prognosis less than 3 months, inability to tolerate surgery, multiple areas of compression, or radiosensitive tumors. An ambulatory patient with a stable spine should be considered for radiation treatment only. The role of chemotherapy for epidural metastatic tumors is not well established. For intramedullary metastases, the role of surgery and chemotherapy remains controversial and radiation is the mainstay. For low-grade or benign primary spinal cord tumors, resective surgery is of benefit and can be curative. For high-grade tumors, the benefit of resection is less clear, and radiotherapy and/or chemotherapy may be helpful. The use of chemotherapy for primary spinal cord tumors has rarely been assessed. Agents reported in the literature for treatment of spinal cord gliomas include temozolomide, irinotecan, cisplatin, and carboplatin. A multidisciplinary approach is often required to maximize the therapeutic and functional outcome of patients with metastatic and primary spinal cord tumors.

Combination Therapy by Tissue-Specific Suicide Gene and Bevacizumab in Intramedullary Spinal Cord Tumor

“…The current treatment methods for IMSCTs includes surgery, chemotherapy, and radiotherapy. 28,29 Recently, clinical advances in multi-modality treatment, such as chemotherapy combined with radiotherapy, have led to an increase in the survival rate of patients with IMSCTs. 30 In addition to these methods, gene therapy has been explored as a possible alternative approach to overcome IMSCTs.…”

Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

“…A recent suggested dose of dexamethasone for treatment of spinal cord compression is an initial 10 mg intravenous loading dose, followed by 6 to 10 mg every 6 hours. 3 Compared to an older alternative that proposes a 96 to 100 mg intravenous loading dose followed by 24 mg every 6 hours, this more current recommendation is much more cautious. However, these plans are merely suggestions, and the optimal dexamethasone dose is still not yet definitively established for the treatment of MSCC.…”

“…2 Clinical symptoms associated with spinal tumors are derived from the disruption of spinal cord tracts, nerve roots, and cerebrospinal fluid flow pathways with specific symptoms dependent on the location of the tumor. 3 The most common presenting symptom is nocturnal back pain, with other common symptoms including lower extremity weakness (with possible loss of ambulation), sensory loss, and altered bowel and bladder function. Patients may be either ambulatory or paraplegic at the time of diagnosis of MSCC.…”

Primary spinal glioblastoma multiforme

“…Then, 21 days after combined therapy, TMZ was continued at an increased dose of 200 mg/m 2 for 5 days and repeated every 28 days for subsequent cycles. [9] During the early stage of these adjuvant treatments, the patient experienced no associated severe hematotoxic effects, and she required no interruptions or delays in treatment because of hematotoxicity.…”