Skip to main content

Radiation Therapy of Metastatic Spinal Cord Compression. Multidisciplinary team diagnosis and treatment

Abstract

Purpose: To evaluate the effectiveness of a multidisciplinary approach to spinal cord compression (SCC) in accordance with prospective protocol, providing a uniform approach to diagnosis, decision making concerning optimal treatment modality in any particular case of SCC, treatment performance and evaluation of treatment results. The SCC patients treated by radiation therapy are described.

Materials and Methods: Patients with SCC were examined and treated by a multidisciplinary team consisting of a neurologist, radiologist, oncologist, orthopedic surgeon, and neurosurgeon. Seventy-nine patients for whom radiation was recommended received a 30 Gy radiation dose to a compression-causing mass and course of high dose dexamethasone. Three fractions of 5 Gy and 5 fractions 3 Gy each were delivered by Co60 or 8 MV photon beam in 12 days. Treatment outcome was essentially evaluated by ambulation capabilities which were considered to be the main problem of SCC. Changes in other neurologic motor, sensory and autonomic disturbances were also evaluated.

Results: Seventy-two percent of the patients were already non-ambulatory at diagnosis. The first symptom was motor deficiency in only 33% of them while in all other cases it was pain. Ambulation capability was the main prognosticator of treatment outcome; 90% of patients who were ambulatory before treatment remained so while 33% of the non-ambulatory patients regained their ability to walk. The grade of motor disturbance was also an important variable: among the non-ambulatory patients, 50% of the paretic but only 14% of the plegic ones became ambulatory. Overall, 51% of the study patients were ambulatory after undergoing radiation. The ambulatory state after treatment was the main predictor for survival.

Conclusion: Close cooperation of a multidisciplinary team in diagnosis and treatment according to the above protocol enabled the achievement of good results of radiation treatment in SCC. Early diagnosis and early treatment should further enhance therapeutic outcome.

This is a preview of subscription content, access via your institution.

References

  1. Boogerd W, van der Sande JJ: Diagnosis and treatment of spinal cord compression in malignant disease. Cancer Treat Rev 19: 129–150, 1993

    Google Scholar 

  2. Helweg-Larsen S: Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand 94: 269–275, 1996

    Google Scholar 

  3. Wallington M, Mendis S, Premawardhana U, Sanders P, Shahsavar-Haghighi K: Local control and survival in spinal cord compression from lymphoma and myeloma. Radiother Oncol 42: 43–47, 1997

    Google Scholar 

  4. Greenberg HS, Kim J-H, Posner JB: Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol 8: 361–366, 1980

    Google Scholar 

  5. Acikgoz B, Akkurt C, Erbengi A, Bertan V, Ozgen T, Ozcan O: Metastatic spinal cord tumors. Paraplegia 27: 359–363, 1989

    Google Scholar 

  6. Byrne TN: Spinal cord compression from epidural metastases. N Engl J Med 327: 614–619, 1992

    Google Scholar 

  7. Grant R, Papadopoulos SM, Sandler HM, Greenberg HS: Metastatic epidural spinal cord compression: current concepts and treatment. J Neurooncol 19: 79–92, 1994

    Google Scholar 

  8. Leviov M, Dale J, Stein M, Ben-Shahar M, Ben-Arush M, Milstein D, Goldsher D, Kuten A: The management of metastatic spinal cord compression: a radiotherapeutic success ceiling. Int J Radiat Oncol Biol Phys 27: 231–234, 1993

    Google Scholar 

  9. Maranzano E, Latini P: Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys 32: 959–967, 1995

    Google Scholar 

  10. Bach F: Metastatic spinal cord compression. Top Support Care 11: 4–5, 1993

    Google Scholar 

  11. Boogerd W: Central nervous system metastasis in breast cancer. Radiother Oncol 40: 5–22, 1996

    Google Scholar 

  12. Bracken NB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Sumers L, Maroon J, Marshall LF, Perot PL, Piepmeier J, Sonntag VKH, Wagner FC, Wilberger JE, Winn HR: A randomized controlled trial of methylprednisone or Naloxone in the treatment of acute spinal cord injury. N Engl J Med 322: 1405–1411, 1990

    Google Scholar 

  13. Sorensen S, Helveg-Larsen S, Mouridsen H, Hansen HH: Effect of high dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomized trial. Eur J Cancer 30A: 22–27, 1994

    Google Scholar 

  14. Delattre JY, Arbit E, Thaler HT, Rosenblum MK, Posner JB: A dose-response study of dexamethasone in a model of spinal cord compression caused by epidural tumor. J Neurosurg 70: 920–925, 1989

    Google Scholar 

  15. Vecht CJ, Haaxma-Reiche H, van Putten WL, de Visser, Vries EP, Twijnstra A: Initial bolus of conventional versus highdose dexamethasone in metastatic spinal cord compression. Neurology 39: 1255–1257, 1989

    Google Scholar 

  16. Mc-Kinley WO, Conti-Wyneken AR, Vokac CW, Cifu DX: Rehabilitative functional outcome of patients with neoplastic spinal cord compressions. Arch Phys Med Rehabil 77: 892–895, 1996

    Google Scholar 

  17. Maranzano E, Latini P, Beneventi S, Perruci E, Panizza BM, Aristei C, Lupattelli M, Tonato M: Radiotherapy without steroids in selected metastatic spinal cord compression patients. Am J Clin Oncol 19: 179–183, 1996

    Google Scholar 

  18. Young RF, Post EM, King GA: Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 53: 741–748, 1980

    Google Scholar 

  19. Janajan NA: Radiotherapeutic management of spinal metastases. J Pain Symptom Manage 11: 47–56, 1996

    Google Scholar 

  20. Findlay GF: The role of vertebral body collapse in the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry 50: 151–154, 1987

    Google Scholar 

  21. Tomita T, Galicich JH, Sundaresan H: Radiation therapy for epidural metastasis with complete block. Acta Radiol Oncol 22: 135–143, 1983

    Google Scholar 

  22. Osborn JL, Getzenberg RH, Trump DL: Spinal cord compression in prostate cancer. J Neurooncol 23: 135–147, 1995

    Google Scholar 

  23. Copeman MC: Presenting symptoms of neoplastic spinal cord compression. J Surg Oncol 37: 24–25, 1988

    Google Scholar 

  24. Helveg-Larsen S, Sorensen PS: Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients. Eur J Cancer 30A: 396–398, 1994

    Google Scholar 

  25. Malik S, Krasnov S, Wadleigh R, Arcenas A, Lee C: Metastatic spinal cord compression in a veteran hospital population (Abstr.). Proc Ann Meet Am Soc Clin Oncol 13: A1608, 1994

    Google Scholar 

  26. Hankenson R, Nevinny H, Hankenson A, Brunk F, Stark J, Miller D, Williams RM: Malignant epidural spinal cord compression in breast cancer (Abstr.). Proc Ann Meet Am Soc Clin Oncol 12: Al44, 1993

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kovner, F., Spigel, S., Rider, I. et al. Radiation Therapy of Metastatic Spinal Cord Compression. Multidisciplinary team diagnosis and treatment. J Neurooncol 42, 85–92 (1999). https://doi.org/10.1023/A:1006124724858

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006124724858

  • metastatic spinal cord compression
  • radiation therapy
  • early diagnosis
  • urgent treatment
  • multidisciplinary