title: Outcomes After Irradiation of Epidural Spinal Cord Compression Due to Metastatic Thyroid Cancer.
abstract: OBJECTIVE
  Epidural spinal cord compression (ESCC) from thyroid cancer is uncommon. This study aimed to contribute to the identification of the most appropriate treatment for these patients.
  
  
  METHODS
  Fourteen patients receiving irradiation alone were retrospectively evaluated.
  
  
  RESULTS
  Improvement of motor deficits occurred in 36% of patients, further progression was prevented in another 43% (overall response=79%). One of six non-ambulatory patients (17%) became ambulatory. The 12-month rate of freedom from in-field recurrence was 85%; long-course irradiation was superior to short-course irradiation (100% vs. 67%, p=0.11). The 12-month survival rate was 41%. Age <70 years (p=0.007), no other metastases (p=0.007), differentiated cancer (p<0.001), ability to walk (p=0.015), affection of 1-3 vertebrae (p<0.001) and better performance score (p=0.007) were associated with survival.
  
  
  CONCLUSIONS
  Irradiation resulted in a good response. Neurosurgery appears required for non-ambulatory patients to restore walking ability. Long-course irradiation resulted in excellent long-term freedom from in-field recurrence and appears preferable for patients with favorable survival prognoses.
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany rades.dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Käsmann
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
authors.forename: Louisa
authors.initials: L
authors.lastname: Bolm
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020127:Recovery of Function; D013117:Spinal Cord Compression / Q000532:radiotherapy*; D013131:Spine / Q000473:pathology; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome; D016138:Walking
keywords: Thyroid cancer; epidural spinal cord compression; freedom from recurrence; functional outcomes; irradiation; survival