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Diagnostic and Therapeutic Strategies for Patients with Malignant Epidural Spinal Cord Compression

  • Neuro-oncology (GJ Lesser, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Malignant epidural spinal cord compression (MESCC) is an oncologic emergency with the potential for devastating consequences for patients if not promptly diagnosed and treated. MESCC is diagnosed by imaging. MRI is by far the most sensitive test, preferably with gadolinium. Once the diagnosis of MESCC is suspected, patients with neurologic deficits should receive prompt administration of dexamethasone with a 10-mg IV loading dose followed by 4 mg every 6 h. Quick taper is recommended once the definitive treatment is established. Consultation with medical oncology, radiation oncology, and neurosurgery is imperative in order to facilitate a multidisciplinary approach. Although spine surgery is the most effective method for relief of cord compression and is necessary if there is spinal instability, surgery is only used in selected patients because most patients have a poor overall condition and short life expectancy. Radiation therapy, therefore, is the most commonly used therapy for patients with MESCC after surgical decompression or in patients who are not surgical candidates. Conventional fractionated radiation alone can achieve modest neurologic outcomes in selected radiosensitive tumors. Radiosurgery techniques which deliver intense focal irradiation to a delimited area with imaging guidance and contoured radiation delivery to the shape of the tumor have recently emerged as increasing effective treatments in MESCC, especially in radioresistant tumors. Stereotactic radiosurgery and different radiation technologies have been studied in recent clinical trials.

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Authors and Affiliations

  1. Department of Medicine, Division of Oncology, Washington University in St Louis School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO, 63110, USA

    Dilan A. Patel MD & Jian L. Campian MD, PhD

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  1. Dilan A. Patel MD
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  2. Jian L. Campian MD, PhD
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Correspondence to Jian L. Campian MD, PhD.

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Dilan A. Patel and Jian L. Campian declare they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Neuro-oncology

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Patel, D.A., Campian, J.L. Diagnostic and Therapeutic Strategies for Patients with Malignant Epidural Spinal Cord Compression. Curr. Treat. Options in Oncol. 18, 53 (2017). https://doi.org/10.1007/s11864-017-0497-6

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  • DOI: https://doi.org/10.1007/s11864-017-0497-6

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