<p>Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review</p>

Abstract

Background: Intramedullary spinal cord metastases (ISCM) in malignancies is a devastating issue with limited research. This study aims to identify the clinical features, management, prognostic factors, and outcomes of this special entity. Methods: A retrospective review of 61 patients of ISCM diagnosed and treated in our institute from June 2010 to March 2018 was conducted (lost to follow-up: 3). Data were retrieved according to the items including age, gender, primary tumor, interval to the ISCM occurrence, ISCM segments, and other synchronous metastases. The interventions, response, prognostic factors, and outcomes of ISCM were systematically analyzed. Results: Lung cancer (67.21%) was the commonest ISCM source, followed by breast cancer (14.75%). In total, 9.84% of patients presented with ISCM initially. The mean span from the primaries to ISCM was 18.77 months (range=0–10 years). The thoracic segment was most commonly involved (77.05%), followed by cervical (39.34%), lumbar level (34.43%), and conus medullaris (6.56%). The management of ISCM was challenging, since 55.74% of individuals had a poor physical condition (PS=3–4) and 72.41% had widespread dissemination synchronously (≥2 organs). Radiotherapy (RT) attained an objective response rate (ORR) of 61.90% or 62.50% and a local control rate (LCR) of 90.48% or 87.50% for symptoms used alone or with other strategies, respectively. ISCM bears a dismal prognosis, with a median overall survival (OS) of 4 months. Patients with only one segment involved had an apparently better prognosis than those with 2–4 involved segments (median OS=7.0 vs 3.0 months) ( P <0.01). The OS of patients treated was remarkably superior to those without any intervention (median OS=5.0 vs 2.0 months) ( P <0.01). Conclusion: ISCM is a distinct entity needing more attention for high cancer incidence, prolonged survival, and lack of research. RT is the mainstay with satisfactory effect. Multiple spinal cord segments involvement and no treatment are poor prognostic factors of OS.

Image-Guided Robotic Radiosurgery for the Management of Intramedullary Spinal Cord Metastases—A Multicenter Experience

“…Overall, our patients were also younger in comparison to other case series and existing review data [6,13,14,22,34]. Systemic progression was the main cause of death, which is also contradictory to previous reports of Goyal et al and Payer et al [5,14].…”

Intramedullary spinal cord metastasis of gastric cancer

“…[ 3 ] Since ISCM is typically recognized in the later stage of cancer treatment, the prognosis of patients with ICSM is usually extremely poor and median survival time is reported as 3–4 months on average. [ 2 3 6 ]…”

“…Due to the small number of treated cases, there is still no consensus regarding the treatment of ISCM. [ 2 ] Therapeutic options include steroid administration, radiotherapy, chemotherapy, and surgical extirpation, with radiation therapy and steroid administration probably being selected most often. [ 12 ] However, there is controversy regarding the effect or risk of radiation therapy because the maximum permissible radiation dose for the spinal cord is limited.…”

“…Although intramedullary spinal cord metastasis (ISCM) is rare, the incidence of ISCM has been recently increasing because of improvement in overall survival of cancer patients thanks to recent advanced therapies, such as molecular targeted drugs, anticancer agents, and various irradiation techniques. [ 1 ] In most cases of ISCM, lung and breast carcinomas are the common primary cancers,[ 2 ] and ISCM from gastric carcinoma has only rarely been reported in the literature. Due to the difficulty in radiological diagnosis, the extremely low frequency of treated cases and poor prognosis, the optimal treatment strategy for ISCM from gastric cancer has not been established, although palliative treatment with steroid administration, radiation therapy, or surgery might be viable options.…”

Management of central nervous system metastases

“…In surgical technical aspect, as the microscopic surgical skill has been advanced and neurophysiologic intraoperative monitoring (IOM) has been developed, surgical outcome gradually improved. Some groups claim that the ISCM shows fair borderline that normal neural structure is well preserved along surgery, however, some groups assert the opposite 12,25) . There is little evidence that surgical resection could improve OS, however, neurologic improvement has been achieved in some reports 12,40) .…”