Treatment of spinal epidural metastasis improves patient survival and functional state.
OBJECTIVE
To determine factors affecting the success of radiation therapy (RT) of spinal epidural metastases and patient survival after RT.


METHODS
One hundred thirty-nine male veterans with an initial spinal epidural metastases treated with dexamethasone and RT were evaluated prospectively. Patients were followed until death.


RESULTS
At presentation, 84 patients could walk. After RT, 119 patients walked. The likelihood of regaining ambulation increased if treatment began <12 hours after loss of ambulation and if patients had bladder and bowel function and sacral sensory sparing. Treatment reduced pain levels, and ambulatory patients had less pain compared with nonambulatory patients. Median length of survival was 104 weeks for ambulatory patients and 6 weeks for nonambulatory patients. Mean interval between loss of ambulation and death was 4.0 +/- 0.5 weeks. Recurrent spinal epidural metastases occurred in 8.63% of patients.


CONCLUSIONS
Patients who walked after treatment lived longer, were ambulatory for most of their remaining life, had less pain, and had a lower incidence of depression.
Zaidat
Osama O
OO
Neurology Service and Rehabilitation and Spinal Cord Injury and Dysfunction Care Line, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Ruff
Robert L
RL
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D003863:Depression / Q000517:prevention & control; D003907:Dexamethasone / Q000627:therapeutic use; D015174:Epidural Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D009364:Neoplasm Recurrence, Local; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D020127:Recovery of Function / Q000528:radiation effects; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone