Treatment of patients with spinal metastases from head and neck neoplasms.
BACKGROUND
Spinal metastases are uncommon in patients with advanced head and neck cancer. Treatment strategies in this patient group have not been defined. Although it has been established that neurologic dysfunction in patients with spinal metastases and cord compression constitutes an oncologic emergency, the role of surgical treatment remains controversial.


OBJECTIVE
To clarify the treatment options in patients with head and neck cancer who develop spinal metastases.


METHODS
The clinical course of patients seen at our institution with head and neck neoplasms and spinal metastases from January 1992 to January 2000 was reviewed.


RESULTS
Eleven patients were identified. Nine developed spinal metastases more than 3 months after the diagnosis of advanced head and neck cancer. The other 2 presented with synchronous spinal involvement and skull base neoplasms. Patients without neurologic symptoms were offered intravenous steroids and palliative radiation. Patients with neurologic symptoms were treated with either intravenous steroids and radiation or surgical decompression and spinal fusion. In 1 patient, no improvement occurred within the first 2 days of radiotherapy, and the patient underwent surgical decompression. Patients with an unstable spine underwent surgical decompression and spinal fusion. Patients with a life expectancy of more than 6 months and neurologic symptoms were offered surgical therapy. In the 9 patients with advanced cancer, the average survival time was 3 months. Two of these patients have survived longer than 6 months.


CONCLUSIONS
We propose that surgical decompression is a viable, justifiable option for selected patients with advanced head and neck cancer and spinal cord compression. Furthermore, we recommend surgical decompression as a first option in patients with an unstable bony spine and/or in whom survival is expected to be longer than 6 months. Finally, we propose a patient management algorithm in these cases.
Preciado
Diego A
DA
Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Box 396, Mayo Memorial Building, 420 Delaware St SE, Minneapolis, MN 55455, USA. preci001@tc.umn.edu
Sebring
Leslie A
LA
Adams
George L
GL
D000328:Adult; D000368:Aged; D000465:Algorithms; D019299:Decompression, Surgical; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D018579:Patient Selection; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy*