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Chemoembolization for Symptomatic Metastatic Epidural Spinal Cord Compression Refractory to Re-radiotherapy



To evaluate the efficacy of chemoembolization for inoperable metastatic epidural spinal cord compression (MESCC) refractory to re-radiotherapy.


Nineteen consecutive patients with recurrent MESCC after re-radiotherapy who had undergone chemoembolization were retrospectively analyzed. Outcome measures were pain relief rate, neurological improvement rate, objective response rate, and adverse events. MESCC degree classification was assessed using Bilsky grades. Pain assessment was performed using Numerical Rating Scale, and neurological function was evaluated using the Frankel classification.


The median follow-up period was 7 (range 2–44) months. All participants had MESCC grade 2 or higher and had severe pain. Fifteen patients (79%) had neurological deficits, and ten had Frankel classification C and five had D. Symptoms were relieved in almost all patients the day following chemoembolization. Pain relief was achieved in 18 of 19 (95%) patients; the median decrease in Numerical Rating Scale score was 8 (range 0–10; p < 0.001). Neurological improvement was achieved in 11 of 15 patients (73%); the median increase in Frankel classification was 1 (range 0–2; p = 0.006). Ten of 19 (53%) patients showed a reduction in MESCC; the median decrease in Bilsky grade was 1 (range 0–2; p = 0.005). There was no correlation between the change in Bilsky grade and pain relief (p = 0.421). However, the decrease in Bilsky grade significantly improved neurological symptoms (p = 0.01). No serious adverse events occurred.


Chemoembolization may be a useful palliative treatment modality for MESCC refractory to re-radiotherapy.

Level of Evidence

Level 3b, Follow up Study.

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  1. 1.

    Loblaw DA, Laperriere NJ, Mackillop WJ. A population-based study of malignant spinal cord compression in Ontario. Clin Oncol. 2003;15:211–7.

    CAS  Article  Google Scholar 

  2. 2.

    Coleman R, Hadji P, Body JJ, et al. On behalf of the ESMO guidelines committee. Bone health in cancer: ESMO clinical practice guidelines. Ann Oncol. 2020;31:1650–63.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol. 2007;25:1423–36.

    Article  PubMed  Google Scholar 

  4. 4.

    Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Kim JM, Losina E, Bono CM, et al. Clinical outcome of metastatic spinal cord compression treated with surgical excision ± radiation versus radiation therapy alone: a systematic review of literature. Spine. 2012;37:78–84.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Expert Panel on Radiation Oncology-Bone metastases, Lo SS, Ryu S, Chang EL, et al. ACR appropriateness criteria® metastatic epidural spinal cord compression and recurrent spinal metastasis. J Palliat Med. 2015;18:573–584.

    Article  Google Scholar 

  7. 7.

    Mavrogenis AF, Angelini A, Vottis C, et al. Modern palliative treatments for metastatic bone disease: awareness of advantages, disadvantages, and guidance. Clin J Pain. 2016;32:337–50.

    Article  PubMed  Google Scholar 

  8. 8.

    Huisman M, van den Bosch MA, Wijlemans JW, van Vulpen M, van der Linden YM, Verkooijen HM. Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2012;84:8–14.

    Article  PubMed  Google Scholar 

  9. 9.

    Sayed D, Jacobs D, Sowder T, Haines D, Orr W. Spinal radiofrequency ablation combined with cement augmentation for painful spinal vertebral metastasis: a single-center prospective study. Pain Physician. 2019;22:E441–9.

    Article  Google Scholar 

  10. 10.

    Shaibani A, Ali S, Bhatt H. Vertebroplasty and kyphoplasty for the palliation of pain. Semin Intervent Radiol. 2007;24:409–18.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Facchini G, Di Tullio P, Battaglia M, et al. Palliative embolization for metastases of the spine. Eur J Orthop Surg Traumatol. 2016;26:247–52.

    Article  PubMed  Google Scholar 

  12. 12.

    Kato T, Nemoto R, Mori H, Takahashi M, Harada M. Arterial chemoembolization with mitomycin C microcapsules in the treatment of primary or secondary carcinoma of the kidney, liver bone and intrapelvic organs. Cancer. 1981;48:674–80.

    CAS  Article  Google Scholar 

  13. 13.

    Nagata Y, Mitsumori M, Okajima K, et al. Transcatheter arterial embolization for malignant osseous and soft tissue sarcomas II clinical results. Cardiovasc Intervent Radiol. 1998;21:208–13.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Chiras J, Adem C, Vallee JN, Spelle L, Cormier E, Rose M. Selective intra-arterial chemoembolization of pelvic and spine bone metastases. Eur Radiol. 2004;14:1774–80.

    Article  PubMed  Google Scholar 

  15. 15.

    Koike Y, Takizawa K, Ogawa Y, et al. Transcatheter arterial chemoembolization (TACE) or embolization (TAE) for symptomatic bone metastases as a palliative treatment. Cardiovasc Intervent Radiol. 2011;34:793–801.

    Article  PubMed  Google Scholar 

  16. 16.

    Nieder C, Grosu AL, Andratschke NH, Molls M. Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys. 2006;66:1446–9.

    Article  PubMed  Google Scholar 

  17. 17.

    Bilsky MH, Laufer I, Fourney DR, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13:324–8.

    Article  PubMed  Google Scholar 

  18. 18.

    Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58.

    Article  PubMed  Google Scholar 

  19. 19.

    Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I Paraplegia. 1969;7:179–92.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine. 2005;30:2186–91.

    Article  PubMed  Google Scholar 

  21. 21.

    Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40:1141–6.

    CAS  Article  Google Scholar 

  22. 22.

    Patsalides A, Yamada Y, Bilsky M, Lis E, Laufer I, Gobin G. Spinal intraarterial chemotherapy: interim results of a phase I clinical trial. J Neurosurg Spine. 2016;24:217–22.

    Article  PubMed  Google Scholar 

  23. 23.

    Soo CS, Wallace S, Chuang VP, Carrasco CH, Phillies G. Lumbar artery embolization in cancer patients. Radiology 1982;145:655–659.;145.3.6183709.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Uemura A, Fujimoto H, Yasuda S, et al. Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma. Eur Radiol. 2001;11:1457–62.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Coldwell DM, Stokes KR, Yakes WF. Embolotherapy: agents, clinical applications and techniques. Radiographics. 1994;14:623–43.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Rossi G, Mavrogenis AF, Casadei R, et al. Embolization of bone metastases from renal cancer. Radiol med. 2013;118:291–302.

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Joichi Heianna.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This single-center, retrospective study was approved by the institutional ethics review board of our institution.

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Heianna, J., Makino, W., Toguchi, M. et al. Chemoembolization for Symptomatic Metastatic Epidural Spinal Cord Compression Refractory to Re-radiotherapy. Cardiovasc Intervent Radiol 44, 1945–1953 (2021).

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