Metastatic spinal cord compression secondary to lung cancer.

Bach, Flemming W.; Agerlin, Niels; Sørensen, Jens Benn; Rasmussen, Torben Riis; Dombernowsky, P; Sørensen, Per Soelberg; Hansen, H H

doi:10.1200/jco.1992.10.11.1781

Cited by 57 publications

(25 citation statements)

References 19 publications

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“…Functional outcome was acceptable in the entire cohort of 73 patients, 68.5 % (50 of 73) of the patients were able to walk 4 weeks after decompression; 51.5 % (17/33) of nonambulatory patients before operation regained the ability to walk. 74-84 % of patients were able to walk after surgery [2,5] and 22-68 % of nonambulatory patients became ambulatory again in other studies [5,7].…”

Section: Discussionmentioning

confidence: 82%

“…Maranzano et al [4] stated that the choice of radiotherapy alone or surgery in MSCC depended on accurate patient selection. Recently, only a few studies specifically addressed surgical treatment of MSCC in lung cancer [5][6][7]. Generally speaking, good surgical results are obtained from lung cancer patients with MSCC, while who may benefit from decompressive surgery remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression

et al. 2015

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Purpose This study aims to create and validate a score for survival and functional outcome of lung cancer patients with metastatic spinal cord compression (MSCC) after posterior decompressive surgery. Methods The entire cohort of 73 consecutive patients was randomly assigned to a test group (N = 37) and a validation group (N = 36). In the test group, we retrospectively analyzed 10 preoperative characteristics. Characteristics significantly associated with survival on multivariate analysis were included in the score. Patients in the validation group were used to confirm whether the score was reproducible. Postoperative functional outcome was analyzed both in the test and validation groups. Results On multivariate analysis, preoperative ambulatory status (P = 0.0017), visceral metastases (P = 0.0002), and time developing motor deficits (P = 0.0004) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 0 to 6 points, two risk groups were designed: 0-2 and 3-6 points and the median survival was 2.6 months (95 % CI, 1.0-3.8 months) and 10.7 months (95 % CI, 7.1-13.7 months), respectively (P \ 0.0001). In the validation group, the corresponding median survival was 2.7 months (95 % CI, 1.6-5.5 months) and 10.8 months (5.8-13.6 months), respectively (P \ 0.0001). In addition, the functional outcome was worse in patients with 0-2 points than in patients with 3-6 points both in the test (P = 0.0023) and validation groups (P = 0.0298). Conclusion Patients with scores of 0-2 points, who have short survival time (life expectancy less than 3 months) and poor functional outcome, appear best treated with radiotherapy or best supportive care alone. Surgery may be no longer in consideration in most of the patients in this group. Patients with score of 3-6 points should be surgical candidates, because survival prognosis (life expectancy more than 10 months) and functional outcome are favorable after surgery.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression

et al. 2015

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“…There was 1 RCT, 37 2 prospective cohort trials, 14,22 and 14 retrospective case series. 2,3,6,7,15,17,19,23,[25][26][27][28]31 As regards neurological outcomes for laminectomy alone without instrumentation for stabilization, Class II data are provided by Young et al 37 In their RCT of 29 patients, laminectomy followed by radiotherapy (RT) was compared with RT alone for the treatment of spinal metastases. Inclusion criteria were a neurological symptom, myelographic extradural block, and tissue diagnosis of metastasis.…”

Section: Posterior Laminectomy With and Without Instrumentationmentioning

confidence: 99%

“…3 In a follow-up study, Bach et al evaluated outcomes in patients experiencing MSCC due to lung carcinoma and found similar data when comparing the efficacy of PL with that of RT (PL = 48%, RT = 46%, PL+RT = 67%). 2 Chaichana et al 6 (78 patients) evaluated the use of PL on metastatic epidural spinal cord compression based on tumor location and the patient's circumstances. 6 Of the 55 patients who were able to ambulate preoperatively, 24 (44%) underwent a PL.…”

Section: Posterior Laminectomy With and Without Instrumentationmentioning

confidence: 99%

Posterior approaches for symptomatic metastatic spinal cord compression

Molina

Goodwin

Abu-Bonsrah

et al. 2016

FOC

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Surgical interventions for spinal metastasis are commonly performed for mechanical stabilization, pain relief, preservation of neurological function, and local tumor reduction. Although multiple surgical approaches can be used for the treatment of metastatic spinal lesions, posterior approaches are commonly performed. In this study, the role of posterior surgical procedures in the treatment of spinal metastases was reviewed, including posterior laminectomy with and without instrumentation for stabilization, transpedicular corpectomy, and costotransversectomy. A review of the literature from 1980 to 2015 was performed using Medline, as was a review of the bibliographies of articles meeting preset inclusion criteria, to identify studies on the role of these posterior approaches among adults with spinal metastasis. Thirty-four articles were ultimately analyzed, including 1 randomized controlled trial, 6 prospective cohort studies, and 27 retrospective case reports and/or series. Some of the reviewed articles had Level II evidence indicating that laminectomy with stabilization can be recommended for improvement in neurological outcome and reduction of pain in selected patients. However, the use of laminectomy alone should be carefully considered. Additionally, transpedicular corpectomy and costotransversectomy can be recommended with the expectation of improving neurological outcomes and reducing pain in properly selected patients with spinal metastases. With improvements in the treatment paradigms for patients with spinal metastasis, as well as survival, surgical therapy will continue to play an important role in the management of spinal metastasis. While this review presents a window into determining the utility of posterior approaches, future prospective studies will provide essential data to better define the roles of the various options now available to surgeons in treating spinal metastases.

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“…Nadal jednak toczą się dyskusje dotyczące wyboru najbardziej efektywnej formy frakcjonowania dawki, dawki całkowitej czy też sposobu kojarzenia RT z innymi metodami leczenia, jak terapią izotopową, lekami modulującymi metabolizm tkanki kostnej czy leczeniem operacyjnym [5,6]. Z powodu odmienności okolic anatomicznych, w których występuje przerzut, różnej liczebności przerzutów (całkowita masa przerzutów) u danego chorego oraz różnorodności sposobów frakcjonowania dawki i jej specyfikacji w RT, jak również niedoskonałości w metodach oceniających ból u chorych, niejednokrotnie trudno jest wskazać najlepszy sposób napromieniania [7][8][9][10].…”

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Przerzuty do układu kostnego w przebiegu raka stercza: rola radioterapii

Milecki

2014

Zeszyty Naukowe WCO, Letters in Oncology Science

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Metastatic spinal cord compression secondary to lung cancer.

Abstract: Despite a short survival, early diagnosis and immediate treatment is crucial because it may preserve the gait function in 97% of lung cancer patients who develop malignant spinal cord compression.

Cited by 57 publications

References 19 publications

A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression

A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression

Posterior approaches for symptomatic metastatic spinal cord compression

Przerzuty do układu kostnego w przebiegu raka stercza: rola radioterapii

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