Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases

Abstract

We report and analyze a rare entity of intramedullary spinal cord tumor, which is metastatic from colon cancer with a very poor prognosis. The reported 19 cases including our case in the literature are analyzed. Comparison of outcomes between surgery, radiotherapy and non-treatment groups are evaluated. Life distribution is profiled. Median overall survival is 75 days. The 90 days and 150 days survival rate are 42.9% and 21.4%, respectively. There were no differences between conservative treatment (non-treatment or radiotherapy) and aggressive intervention (surgery or surgery plus radiotherapy) in mortality and the trend of survival probability. The prognosis of metastatic intramedullary spinal cord tumor is poor. Surgery may only be considered in selected patients with good control of primary cancer and without evidence of lung metastases and leptomeningeal carcinomatosis.

Intramedullary Spinal Cord Solitary Metastasis as the Inaugural Presentation of Colorectal Cancer: A Case Report

“…The presence of ISCM usually appears associated with widespread metastasis [5,7,12,13], including brain involvement in 61% of cases [12], with 80% mortality rates in first 3 -4 months after the onset [11]. Our patient had already lung and pelvic but not brain metastasis at ISCM diagnosis.…”

“…The conservative treatment is often chosen because of advanced stage of disease and poor clinical condition of patients. On the other hand, we can consider surgery in certain patients, accordingly to their age, physical condition, location and severity of the primary tumor, other metastasis and surgical risk [4] and may offer some improvement in neurologic condition and quality of life in some patients [4,5,10,12]. Despite an early diagnosis, our patient had already advanced disease, with disseminated metastasis and irreversible neurological deficits and so a very poor prognosis.…”

“…This occurred in 22.5-39% of ISCM cases [3,6]. However, the diagnosis tends to become more frequent and easier with the development of newer and better imaging methods, mainly spinal cord magnetic resonance imaging (MRI) [1][2][3][5][6][7][8][9][10][11][12].…”

“…It is more often associated with primary lung cancer, especially small-cell carcinoma, or breast cancer [3]. Colorectal cancer (CRC) represents only 3-5% of cases [3], with very few cases reported in the literature so far [2,5]. ISCM may represent a diagnostic challenge, particularly in the rare cases where it is the first manifestation of the malignancy.…”

“…Yet, ISCM still has a very poor prognosis because at diagnosis patients usually have very advanced disease with widespread metastasis [5,6,8,11,13], with median survival rates of 4 months since the first symptoms [12].…”