Spinal cord compression in cancer patients: Review of diagnosis and treatment

Abstract

Spinal cord compression (SCC) is a well-known complication in cancer patients, with an enormous potential impact on quality of life. In most cases, treatment is palliative, but a prompt diagnosis and immediate treatment is essential to preserving neurological function. Whereas steroids and radiation have been the mainstay of therapy for many years, the role and timing of surgery has remained controversial. However, class I evidence now exists to support the benefit of pre-irradiation surgical decompression in a carefully selected subpopulation of patients with SCC. A multidisciplinary approach is required to maximize the therapeutic and functional outcome of these patients.

Treatment of spinal cord tumors

“…The use of chemotherapy for metastatic spinal cord tumors has never been evaluated in well-designed, randomized trials [3]. The few retrospective studies that exist have failed to show that the addition of chemotherapy provides a statistically signifi cant benefi t. It has been theorized that for some chemosensitive tumors (eg, lymphomas, leukemias, germcell tumors, and neuroblastomas), chemotherapy may be used fi rst or in conjunction with radiation.…”

“…This approach often did not relieve the cord compression and could lead to further spine instability. New surgical techniques via an anterior approach (transthoracic or retroperitoneal) or a lateral approach (transpedicular, costotransverse, lateral extracavitary) have been developed [3]. The anterior techniques provide direct access to the vertebral body.…”

Treatment of Metastatic Spinal Cord Compression: cepo Review and Clinical Recommendations

“…The use of adjuvant highdose steroid in addition to conventional radiotherapy has been shown to be beneficial, but was associated with an increased incidence of severe adverse events. Indeed, high-dose dexamethasone (>96 mg daily) has been associated with serious toxicities such as severe psychoses, gastric ulcer bleeding, rectal bleeding, gastrointestinal perforation, and sepsis 4,7,39 . To summarize, the available evidence demonstrates that high-dose corticosteroid does not appear to be more effective than low-dose treatment, and that dexamethasone at a total daily dose of 16 mg is effective and safe for the treatment of mscc.…”

“…Overall, between 5% and 10% of cancer patients will develop metastatic spinal cord compression (mscc), an oncologic emergency requiring early diagnosis and immediate treatment 4,5 . Spinal cord damage including vascular injury, hemorrhage, white matter edema, and nerve damage such as demyelination and axonal damage, are frequently observed at the site of compression and cause symptoms such as back pain and motor or sensory deficits [6][7][8][9] .…”

“…The main objectives of mscc treatment are preservation or improvement of neurologic function (particularly walking capacity), pain relief, and preservation or improvement of quality of life 7 . The most-used treatment modalities are corticotherapy, radiotherapy, and surgery.…”