M. Leviov et al., THE MANAGEMENT OF METASTATIC SPINAL-CORD COMPRESSION - A RADIOTHERAPEUTIC SUCCESS CEILING, International journal of radiation oncology, biology, physics, 27(2), 1993, pp. 231-234
Citations number
14
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: In assessing the effectiveness of the management of metastati
c spinal cord or cauda equina compression, we performed a retrospectiv
e analysis of 70 patients with this complication whom we treated from
1985 to 1989. Methods and Materials: The most frequent primary diagnos
es in our series were carcinomas of unknown origin and of the breast,
lymphoproliferative disease, lung cancer, and prostatic carcinoma. We
used the Findlay classification to group all patients according to the
ir pre-therapeutic functional motor status as Grade I (24 patients or
34%), Grade II (27, or 39%) or Grade III (19 or 27%). Treatment consis
ted of 30-45 Gy of irradiation (using two different schedules) togethe
r with high-dose dexamethasone; in only five cases was there surgical
intervention. Results: We found that a powerful predictor of response
to radiotherapy was the patient's neurologic status (Findlay grade) at
the time of diagnosis: 66% of previously ambulatory patients remained
so, whereas 30% of non-ambulatory patients and only 16% of paraplegic
patients regained the ability to walk. Another important predictor of
response was primary tumor histology, with the most favorable respons
es to radiation therapy having been observed in lymphoproliferative di
seases and in breast cancer, but with some response in other radiosens
itive malignancies as well. Conclusion: The similarity of our results
to those of other centers leads us to conclude that a radiotherapeutic
success ceiling of 80% may have been reached for Findlay Grade I pati
ents with metastatic spinal cord compression. In view of this, we sugg
est that future therapeutic endeavour would be best directed toward ea
rly diagnosis of the condition.