title: A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression.
abstract: OBJECTIVE
  To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC).
  
  
  METHODS
  A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies.
  
  
  RESULTS
  An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes.
  
  
  CONCLUSIONS
  If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur.
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada. andrew.loblaw@sunnybrook.ca
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Loblaw
authors.forename: Gunita
authors.initials: G
authors.lastname: Mitera
authors.forename: Michael
authors.initials: M
authors.lastname: Ford
authors.forename: Normand J
authors.initials: NJ
authors.lastname: Laperriere
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods; D019583:Dose Fractionation, Radiation; D006801:Humans; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009864:Ontario; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000628:therapy*; D013120:Spinal Cord Neoplasms / Q000556:secondary / Q000628:therapy*; D013256:Steroids / Q000627:therapeutic use; D016138:Walking
chemical_list: D013256:Steroids