title: Assessment of prognostic factors in patients with metastatic epidural spinal cord compression (MESCC) from solid tumor after surgery plus radiotherapy: a single institution experience.
abstract: OBJECTIVE
  To identify potential prognostic factors predicting functional outcome and survival after surgery followed by radiotherapy for metastatic spinal cord compression due to solid tumors.
  
  
  METHODS
  531 consecutive patients with metastatic epidural spinal cord compression (MESCC) were treated at our institution. Surgery followed by radiation therapy was performed in 151 patients (30%) with various histological diagnoses. Three different surgical procedures were performed: minimal resection with or without instrumented fixation, curettage, and total tumorectomy. Within 1 month after surgery, RT was performed, delivering a total dose of 30-36 Gy (3 Gy per fraction). Ten potential prognostic factors were investigated for relationship with functional outcome and survival.
  
  
  RESULTS
  Clinical remission of pain was obtained in 91% of patients and 94 (62.5%) had recovery of neurological deficit. Recurrence in the same site of treatment occurred in nine (6%) patients. Median survival was 14 months (range 0-52 months); OS at 1, 2, and 3 years was 43.6, 37, and 21.5%, respectively. Survival was significantly associated with the histology of primary tumor (P < 0.001) and visceral metastases (P < 0.001) in the whole group; for histology, the prognostic factors statistically significant were other bone metastases in breast cancer, control of primary tumor, and the absence of visceral metastases in NSCLC and kind of surgery in the other.
  
  
  CONCLUSIONS
  The key element for successful treatment of MESCC is multidisciplinary care of the patient, which includes all of those prognostic factors that have been, until now, analyzed and compared. In our set of patients treated for vertebral metastases, PS, time to development of symptoms, and the presence of visceral metastases affected functional outcome and survival.
authors.affiliation: Department of Neurosurgery, Istituto Clinico Humanitas, Rozzano, Italy. ftancioni@libero.it
authors.forename: Flavio
authors.initials: F
authors.lastname: Tancioni
authors.forename: Piera
authors.initials: P
authors.lastname: Navarria
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.forename: Luca
authors.initials: L
authors.lastname: Attuati
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
authors.forename: Marco
authors.initials: M
authors.lastname: Alloisio
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.forename: Riccardo Rodriguez Y
authors.initials: RR
authors.lastname: Baena
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D015174:Epidural Neoplasms / Q000150:complications* / Q000556:secondary* / Q000628:therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D012737:Sex Factors; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome