The role of radiotherapy for metastatic epidural spinal cord compression.
Radiotherapy alone is the most common treatment for metastatic epidural spinal cord compression (MESCC). Decompressive surgery followed by radiotherapy is generally indicated only in 10-15% of MESCC cases. Chemotherapy has an unclear role and may be considered for selected patients with hematological or germ-cell malignancies. If radiotherapy alone is given, it is important to select the appropriate regimen. Similar functional outcomes can be achieved with short-course radiotherapy regimens and longer-course radiotherapy regimens. Longer-course radiotherapy is associated with better local control of MESCC than short-course radiotherapy. Patients with a more favorable survival prognosis (expected survival of ≥6 months) should receive longer-course radiotherapy, as they may live long enough to develop a recurrence of MESCC. Patients with an expected survival of <6 months should be considered for short-course radiotherapy. A recurrence of MESCC in the previously irradiated region after short-course radiotherapy may be treated with another short-course of radiotherapy. After primary administration of longer-course radiotherapy, decompressive surgery should be performed if indicated. Alternatively, re-irradiation can be performed using high-precision techniques to reduce the cumulative dose received by the spinal cord. Larger prospective trials are required to better define the appropriate treatment for the individual patient.
Rades
Dirk
D
Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany. rades.dirk@gmx.net
Abrahm
Janet L
JL
D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D015174:Epidural Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D011879:Radiotherapy Dosage; D013117:Spinal Cord Compression / Q000209:etiology* / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery
D005938:Glucocorticoids
Neurosurg Clin N Am. 2004 Oct;15(4):425-35
15450877
Int J Radiat Oncol Biol Phys. 1995 Oct 15;33(3):595-8
7558948
Spine (Phila Pa 1976). 1989 Dec;14(12):1308-15
2617360
Radiother Oncol. 2003 Aug;68(2):175-80
12972313
Neurology. 1991 May;41(5):744-6
2027494
Eur J Cancer. 1994;30A(1):22-7
8142159
Am J Clin Oncol. 1996 Apr;19(2):179-83
8610645
Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):959-67
7607970
J Neurooncol. 1987;5(2):125-8
3668609
Nat Rev Clin Oncol. 2010 Apr;7(4):220-9
20234353
AMA Arch Neurol Psychiatry. 1953 Dec;70(6):813-9
13103865
J Neurooncol. 1992 Feb;12(2):141-4
1560260
Cancer. 2008 Jan 1;112(1):157-61
17948910
JAMA. 1978 Dec 15;240(25):2771-3
713019
Lancet. 2006 Jan 14;367(9505):109; author reply 109-10
16413870
J Clin Oncol. 1998 Apr;16(4):1613-24
9552073
Strahlenther Onkol. 1999 Oct;175(10):500-8
10554645
J Neurol Neurosurg Psychiatry. 1987 Feb;50(2):151-4
3572429
Comput Med Imaging Graph. 1996 May-Jun;20(3):159-62
8930468
Cancer. 2004 Dec 1;101(11):2687-92
15493037
Clin Oncol (R Coll Radiol). 2003 Jun;15(4):211-7
12846501
Radiother Oncol. 1999 Aug;52(2):101-9
10577695
Leuk Lymphoma. 2002 Feb;43(2):355-9
11999569
Cancer. 1995 Jan 1;75(1):94-8
7804983
Radiother Oncol. 1999 Aug;52(2):111-21
10577696
Int J Radiat Oncol Biol Phys. 2000 Mar 15;46(5):1163-9
10725627
Int J Radiat Oncol Biol Phys. 2005 Nov 1;63(3):872-5
15939549
Lancet. 2005 Aug 20-26;366(9486):643-8
16112300
Strahlenther Onkol. 2006 Dec;182(12):708-12
17149577
Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):314; author reply 314-5
17448887
J Clin Oncol. 2007 Apr 10;25(11):1423-36
17416863
Radiother Oncol. 1997 Jan;42(1):43-7
9132825
Neurosurgery. 2006 May;58(5):891-8; discussion 891-8
16639323
Neurosurgery. 1999 May;44(5):1027-39; discussion 1039-40
10232536
Clin Oncol (R Coll Radiol). 1994;6(1):7-10
8172840
Int J Radiat Oncol Biol Phys. 2003 Jan 1;55(1):162-7
12504049
Neuro Oncol. 2005 Jan;7(1):64-76
15701283
Radiother Oncol. 1998 Jun;47(3):233-40
9681885
Radiother Oncol. 2009 Nov;93(2):174-9
19520448
Neurology. 1977 May;27(5):422-9
558545
Int J Radiat Oncol Biol Phys. 1997 Jul 15;38(5):1037-44
9276370
Ann Neurol. 1978 Jan;3(1):40-51
655653
Int J Radiat Oncol Biol Phys. 1993 Dec 1;27(5):1079-83
8262831
J Neurosurg. 2002 Jan;96(1 Suppl):6-9
11795715
Clin Oncol (R Coll Radiol). 2003 Sep;15(6):345-52
14524489
Neurosurg Focus. 2003 Nov 15;15(5):E1
15323458
J Neurooncol. 1999 Mar;42(1):85-92
10360483
Radiother Oncol. 2001 Jun;59(3):307-9
11369072
AMA Arch Neurol Psychiatry. 1954 Mar;71(3):271-90
13123590
Cancer. 1990 Apr 1;65(7):1502-8
2311062
Spine (Phila Pa 1976). 2007 Jan 15;32(2):193-9
17224814
Cancer. 2010 Aug 1;116(15):3670-3
20564129
J Clin Oncol. 2005 May 20;23(15):3358-65
15738534
Int J Radiat Oncol Biol Phys. 2002 Jul 15;53(4):975-9
12095565
Clin Oncol (R Coll Radiol). 1998;10(1):39-43
9543614
Eur Neurol. 2001;45(4):266-9
11385267
Eur Urol. 2006 May;49(5):846-52; discussion 852
16442206
J Clin Oncol. 2007 Jan 1;25(1):50-6
17194905
Nat Clin Pract Oncol. 2006 Jan;3(1):14-5
16407872
Cancer. 1990 Jan 1;65(1):98-106
2293874
BMJ. 1998 Jul 4;317(7150):18-21
9651261
Int J Radiat Oncol Biol Phys. 2003 Mar 1;55(3):594-605
12573746
Spine (Phila Pa 1976). 1995 Aug 15;20(16):1776-82
7502133
Cancer. 2008 Sep 1;113(5):1090-6
18642349
J Neurosurg. 1985 Aug;63(2):260-5
3926963
JAMA. 2008 Feb 27;299(8):937-46
18314436
Acta Neurochir (Wien). 1990;107(1-2):37-43
2096606
Cancer. 1998 Oct 15;83(8):1593-601
9781953
J Exp Ther Oncol. 2009;8(1):35-41
19827269
Lancet Oncol. 2005 Jan;6(1):15-24
15629272
J Clin Oncol. 2005 May 20;23(15):3366-75
15908648
Acta Radiol. 1997 May;38(3):372-5
9191426
J Clin Oncol. 2006 Jul 20;24(21):3388-93
16849752