Multimodal approach to the management of metastatic epidural spinal cord compression (MESCC) due to solid tumors.
OBJECTIVE
To assess the impact of a multidisciplinary approach for treatment of patients with metastatic epidural spinal cord compression in terms of feasibility, local control, and survival.


METHODS
Eighty-nine consecutive patients treated between January 2004 and December 2007 were included. The most common primary cancers were lung, breast, and kidney cancers. Ninety-eight surgical procedures were performed. Radiotherapy was performed within the first month postoperatively. Clinical outcome was evaluated by modified visual analog scale for pain, Frankel scale for neurologic deficit, and magnetic resonance imaging or computed tomography scan. Nearly all patients (93%) had back pain before treatment, whereas major or minor preoperative neurologic deficit was present in 62 cases (63%).


RESULTS
Clinical remission of pain was obtained in the vast majority of patients (91%). Improvement of neurologic deficit was observed in 45 cases (72.5%). Local relapse occurred in 10%. Median survival was 11 months (range, 0-46 months). Overall survival at 1 year was 43.6%. Type of primary tumor significantly affected survival.


CONCLUSIONS
In patients with metastatic epidural spinal cord compression, the combination of surgery plus radiotherapy is feasible and provides clinical benefit in most patients. The discussion of each single case within a multidisciplinary team has been of pivotal importance in implementing the most appropriate therapeutic approach.
Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy.
Flavio
F
Tancioni
Pierina
P
Navarria
Martin A
MA
Lorenzetti
Paolo
P
Pedrazzoli
Giovanna
G
Masci
Pietro
P
Mancosu
Marco
M
Alloisio
Emanuela
E
Morenghi
Armando
A
Santoro
Riccardo
R
Rodriguez y Baena
Marta
M
Scorsetti
D000328:Adult; D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012074:Remission Induction; D013117:Spinal Cord Compression / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult