Survival Rates of Patients With Metastatic Spinal Cancer After Scintigraphic Detection of Abnormal Radioactive Accumulation

Tatsui, Hikaru; Onomura, Toshinobu; Morishita, Shinobu; Oketa, Masanari; Inoue, Takashi

doi:10.1097/00007632-199609150-00017

Cited by 134 publications

(62 citation statements)

References 14 publications

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“…The efficacies of these treatment protocols are widely accepted and well documented. [21][22][23][24] Despite the large number of patients with spinal metastasis 19,25 there has always been a hesitancy to refer and admit these patients to dedicated SCI units for rehabilitation. Reasons are the general opinion that extensive rehabilitative efforts may either not be tolerated by the terminally ill patient or be futile because of the limited life span.…”

Section: Discussionmentioning

confidence: 99%

“…All tumours were classified according to reported 5-year survival rates of more than 50% (risk group I, eg thyroid carcinoma, lymphoma), 20-50% (risk group II, eg breast carcinoma) and less than 20% (risk group III; eg lung carcinoma, gastrointestinal carcinoma, unknown). 7,[17][18][19] Table 2 summarises the data on the spectrum of tumour pathology.…”

Section: Tumour Typementioning

confidence: 99%

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Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Parsch

Mikut²,

Abel

2003

Spinal Cord

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Study design: Retrospective study utilising clinical records and public administration databases. Objectives: This study was performed to analyse the clinical presentation and survival rate of individuals with spinal cord injury (SCI) due to spinal metastasis after primary treatment, and to evaluate the efficacy of rehabilitative efforts. Setting: Spinal Cord Injury Unit, University Hospital, Heidelberg. Methods: A total of 68 consecutive patients were included. Demographics, clinical data, tumour type, level and completeness of SCI, initial treatment, functional independence measure (FIM) and survival time were derived from hospital and public administration databases. Cox regression and fuzzy logic rule generation were used for statistical analysis. Results: Of the 68 patients, 66 patients died 11 months (median, interquartile range (IQR) 4-29 months) after the onset of neurological symptoms at an average age of 58 years. The functional independence measure (FIM) score describing the general clinical and functional status proved to be the most reliable prognostic factor of survival. Other more specific parameters (eg tumour type or level of lesion) did not have such an impact. In total, 51 patients completed the rehabilitation programme within 50 days (median, IQR 27-99 days). The FIM score improved from 62 at admission to 84 at discharge. Conclusion:The clinical and functional status is a valuable prognostic factor for survival. Since institutionalised rehabilitative efforts are effective, this group of patients should be accepted into such a program.

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Section: Discussionmentioning

confidence: 99%

Section: Tumour Typementioning

confidence: 99%

Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Parsch

Mikut²,

Abel

2003

Spinal Cord

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“…42 Given the presence of an ever-aging population and improvements in systemic treatment for primary tumors, this incidence is likely to increase in the future, contributing significant pain, neurological dysfunction, and immobility in individuals afflicted with this disease. Although palliation is the goal in patients with MESCC, dramatic improvement in quality of life can be obtained when multimodality treatments such as surgical decompression, spinal stabilization, radiation treatment, and chemotherapy are appropriately applied.…”

Section: Discussionmentioning

confidence: 99%

Effect of hyperglycemia on progressive paraparesis in a rat metastatic spinal tumor model

McGirt¹,

Gok²,

Shepherd³

et al. 2009

SPI

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Object Hyperglycemia has been shown to potentiate ischemic injury of the spinal cord by quenching vasodilators and potentiating tissue acidosis and free radical production. Steroid-induced hyperglycemia is a common event in the surgical management of metastatic epidural spinal cord compression (MESCC). The goal in this study was to determine whether experimentally induced hyperglycemia accelerates neurological decline in an established animal model of MESCC. Methods Sixteen Fischer 344 rats underwent a transabdominal approach for implantation of a CRL-1666 breast adenocarcinoma cell line within the vertebral body of L-6. After 72 hours of recovery from tumor implantation, the animals received intraperitoneal injections every 12 hours of either 2 g/kg dextrose in 5 ml 0.09% saline (hyperglycemia, 8 rats) or 5 ml 0.09% saline alone (normoglycemia, 8 rats). Weights were taken daily, and the hindlimb function was tested daily after tumor implantation by using the Basso-Beattie-Bresnahan (BBB) scale (score range 1–21). Animals were killed at time of paralysis (BBB Score < 7), and the volume of epidural tumor growth within the spinal canal was measured. To determine the degree of hyperglycemia induced by this dextrose regimen, a surrogate group of 10 Fischer 344 rats underwent intraperitoneal injections of 2 g/kg dextrose (5 rats) or 0.09% saline (5 rats) every 12 hours, and serum glucose levels were assessed 1, 3, 6, 8, 10, and 12 hours after injections for 24 hours. Results Dextrose versus saline injections resulted in elevated mean serum glucose at 3 (259 vs 103 μg/dl), 6 (219 vs 102 μg/dl), 8 (169 vs 102 μg/dl), and 10 hours (118 vs 99 μg/dl) after injection, returning to normal levels by 12 hours (96 vs 103 μg/dl) just prior to subsequent injection. All rats had normal hindlimb function for the first 8 days after tumor implantation. Hyperglycemic versus normoglycemic rats demonstrated a worsened median BBB score by postimplantation Day 9 (Score 20 vs 21, p = 0.023) through Day 16 (Score 8 vs 12, p = 0.047). Epidural tumor volume demonstrated a near-linear growth rate across both groups; however, hyperglycemic rats developed paralysis earlier (median 15.5 vs 17.5 days, p = 0.0035), with significantly less epidural tumor volume (2.75 ± 0.38 cm3 vs 4 ± 0.41 cm3, p < 0.001) at time of paralysis. Conclusions In a rat model of metastatic epidural spinal cord compression, rats maintained in a hyperglycemic state experienced accelerated time to paralysis. Also, less epidural tumor volume was required to cause paralysis in hyperglycemic rats. These results suggest that hyperglycemic states may contribute to decreased spinal cord tolerance to compression resulting from MESCC. Clinical studies evaluating the effect of aggressive glucose control in patients with MESCC may be warranted.

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“…Survival rates are higher in patients who are ambulatory either before or after radiation [15,47]. Patients with radiosensitive tumors and a single spinal metastasis do best, while patients with lung cancer, multiple vertebral metastases, or visceral or brain metastases have shorter survival [32,[50][51][52]. From the standpoint of neurologic prognosis, about 10% of patients eventually experience local recurrence [53,54].…”

Section: Specific Antineoplastic Therapies Radiation Therapymentioning

confidence: 99%

Spinal Cord Compression

Ribas

Schiff

2012

Curr Treat Options Neurol

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Spinal cord disease represents a major cause of morbidity and suffering in cancer patients. Prevention or minimization of neurologic deficits depends on an understanding of early symptoms, clinical course, and treatment options. Early diagnosis is crucial, as current treatments usually arrest the course of the disease but much less commonly restore lost neurologic function. This article will review the epidemiology, pathophysiology, symptomatology, diagnosis, and management of the causes of spinal cord dysfunction directly related to cancer. It will briefly discuss myelopathies related to paraneoplasia and treatment complications. Epidural spinal cord compressionSpinal cord or cauda equina dysfunction resulting from tumor growth in the spinal epidural space is commonly referred to as epidural spinal cord compression (ESCC). In some ways, spinal epidural metastasis (SEM) may be a better term, as it encompasses the phenomena of root, cauda equina, and minor degrees of thecal sac compression SEM/ESCC is the most common cause of spinal cord dysfunction in cancer patients, and will receive the bulk of attention in this article. EpidemiologyAlthough careful, contemporary population-based studies are unavailable, the best evidence suggests that 5% of patients dying of cancer have suffered ESCC [1]. With more than 500,000 Americans succumbing to cancer yearly, there are likely to be more than 25,000 cases of ESCC yearly in the United States.Neurol Clin N Am

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Survival Rates of Patients With Metastatic Spinal Cancer After Scintigraphic Detection of Abnormal Radioactive Accumulation

Abstract: When managing metastatic spinal tumors, it is essential to select therapeutic methods based on adequate consideration of the features of primary lesions and the expected prognosis.

Cited by 134 publications

References 14 publications

Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Effect of hyperglycemia on progressive paraparesis in a rat metastatic spinal tumor model

Spinal Cord Compression

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