[Radiotherapy of epidural metastases with spinal cord compression].
BACKGROUND
We have evaluated the records of patients who developed epidural metastases with spinal cord compression and underwent X-ray therapy in combination with dexamethasone. The results, prognostic factors and live-tables will be demonstrated.


METHODS
Between 1984 and 1995 48 patients were treated at the Department of Radiooncology at the University of Münster because of epidural metastases. All but 3 cases were histologically proved. Three patients were irradiated without definitive histology because of clinical symptoms and CT or MR-imaging. Only patients with solid tumors were considered-patients with systemic diseases like leukemia or lymphoma were not analysed. In all of our cases irradiation was combined with systemic steroid application. Radiotherapy was performed with cobalt-60 or with an accelerator with total doses between 25 Gy and 40 Gy.


RESULTS
The combination of irradiation and steroids had resulted in pain relief in about 80% of all patients. The ambulatory status after paraparesis was restituted in 35%. Best prognosis had been seen in patients with the following criterions: primary tumor should be breast cancer, no evidence of other tumor manifestation, no signs of paraparesis or paraplegia before the beginning of irradiation or regaining the ambulatory status after therapy. Under these conditions we have calculated a median survival rate of 709 days for these patients with good prognosis. Patients with bronchogenic carcinoma had a very poor prognosis with a median survival rate of only 90 days.


CONCLUSIONS
Epidural metastases in cancer led often to a very fatal outcome. Irradiation is useful for pain relief and also for local tumor control. In some cases in patients with good prognostic factors long-time survival could be demonstrated. The results of irradiation are comparable with those after surgery.
Wagner
W
W
Paracelsus-Strahlenklinik, Osnabrück.
Prott
F J
FJ
Rübe
C
C
Willich
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms; D002283:Carcinoma, Bronchogenic; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D015179:Colorectal Neoplasms; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use; D015174:Epidural Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms; D008175:Lung Neoplasms; D008297:Male; D008545:Melanoma; D008875:Middle Aged; D059408:Pain Management; D010315:Particle Accelerators; D011379:Prognosis; D011471:Prostatic Neoplasms; D011879:Radiotherapy Dosage; D013117:Spinal Cord Compression / Q000209:etiology*; D015996:Survival Rate; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal; D003037:Cobalt Radioisotopes; D003907:Dexamethasone
Strahlentherapie epiduraler Metastasen mit Rückenmarkskompression.