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A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone

Published online by Cambridge University Press:  09 May 2013

L. O'Sullivan ,
A. Clayton-Lea ,
O. McArdle ,
M. McGarry ,
J. Kenny ,
M. Dunne ,
E. O'Shea ,
C. Small ,
M. Moriarty  and
P. Thirion
L. O'Sullivan*
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
A. Clayton-Lea
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
O. McArdle
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
M. McGarry
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
J. Kenny
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
M. Dunne
Affiliation:
Clinical Trials Unit, Saint Luke's Radiation Oncology Network, Dublin, Ireland
E. O'Shea
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
C. Small
Affiliation:
Department of Radiation Oncology, Galway University Hospital, Galway, Ireland
M. Moriarty
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
P. Thirion
Affiliation:
Department of Radiation Oncology, Saint Luke's Radiation Oncology Network, Dublin, Ireland
*
Correspondence to: Lydia O'Sullivan, Department of Radiation Oncology, Saint Luke's Radiation Oncology Network at Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. Tel: 353+ 1 704 5577, 353+ 1 852 8625. Fax: 353+ 1 704 5591. E-mail: lydia.osullivan@slh.ie
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Abstract

Impending malignant spinal cord compression (IMSCC) may be defined as compression of the thecal sac, without any visible pressure on the spinal cord itself. Although there is a perception that IMSCC patients have a better prognosis and less severe clinical symptoms than true malignant spinal cord compression (MSCC) patients, these factors have never been documented in the literature.

Purpose

To record the characteristics, management and functional outcome of a group of patients with IMSCC, who were treated with radiotherapy in our institution, and compare these parameters with similar data on MSCC patients.

Materials and methods

Data (gender, age, primary oncological diagnosis, pain, performance status and neurological status) were prospectively collected for 28 patients. Patients were then followed up post treatment to document their response to treatment and treatment-related toxicity.

Results

The median survival of our group of IMSCC patients is similar to that of an MSCC patient. In addition, the IMSCC group exhibits significant clinical symptoms including neurological deficit.

Conclusion

Although further studies are necessary, we have found that IMSCC patients in this study share similar prognosis and clinical symptoms with MSCC patients. Clinicians should be aware of this when communicating with IMSCC patients and their families, and short-course radiotherapy should be considered.

Keywords

impending spinal cord compressionpalliative radiotherapyspinal cord compression
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 12 , Issue 3 , September 2013 , pp. 218 - 225
Copyright
Copyright © Cambridge University Press 2013 

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References

1.Prasad, D, Schiff, D. Malignant spinal-cord compression. Lancet Oncol 2005; 6: 15–24.CrossRefGoogle ScholarPubMed
2.Abraham, J. Assessment and treatment of patients with malignant spinal cord compression. J Support Oncol 2004; 2: 377–401.Google Scholar
3. National Institute for Health and Clinical Excellence, Metastatic Spinal Cord Compression: Diagnosis and Management of Adults at Risk of and with Metastatic Spinal cord Compression. National Institute for Health and Clinical Excellence Clinical Guideline 75. London: National Institute for Health and Clinical Excellence, 2008.Google Scholar
4.Loblaw, D, Smith, K, Lockwood, Get al. The Princess Margaret Hospital experience of malignant spinal cod compression. Proc Am Soc Clin Oncol 2003; 22: 119 (Abstract 477).Google Scholar
5.Schiff, D. Spinal cord compression. Neurol Clin 2003; 21: 67–86.CrossRefGoogle ScholarPubMed
6.Husband, D J. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ 1998; 3: 18–21.CrossRefGoogle Scholar
7.Prewett, S, Venkitaraman, R. Metastatic spinal cord compression: review of the evidence for a radiotherapy dose fractionation schedule. Clin Oncol 2010; 22: 222–230.CrossRefGoogle ScholarPubMed
8.Williams, M P, Cherryman, G R, Husband, J E. Magnetic resonance in suspected metastatic spinal cord compression. Clin Radiol 1989; 40: 286–290.CrossRefGoogle ScholarPubMed
9.Loblaw, D A, Perry, J, Chambers, A, Laperriere, N J. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: The Cancer Care Ontario Practice Guidelines Initiative's Neuro-Oncology Disease Site Group. J Clin Oncol 2005; 23: 2028–2037.CrossRefGoogle ScholarPubMed
10.Rades, D, Fehlauer, F, Schulte, Ret al. Prognostic factors predicting functional outcomes, recurrence-free survival, and overall survival after radiotherapy for metastatic spinal cord compression in breast cancer patients. Int J Radiat Oncol Biol Phys 2006; 64: 182–188.CrossRefGoogle ScholarPubMed
11.Rades, D, Fehlauer, F, Veninga, Tet al. Functional outcomes and survival after radiotherapy for metastatic spinal cord compression in patients with cancer of unknown primary. Int J Radiation Oncol Biol Phys 2007; 67: 532–537.CrossRefGoogle ScholarPubMed
12.Rades, D, Rudat, V, Veninga, Tet al. A score predicting post treatment ambulatory status in patient irradiated for metastatic spinal cord compression. Int J Radiat Oncol Biol Phys 2008; 72: 905–908.CrossRefGoogle ScholarPubMed
13.Rades, D, Lange, M, Veninga, Tet al. Preliminary results of spinal cord compression recurrence evaluation (score 1) study comparing short course versus long course radiotherapy for local control of malignant epidural spinal cord compression. Int J Radiat Oncol Biol Phys 2009; 73: 228–234.CrossRefGoogle ScholarPubMed
14.Rades, D, Lange, M, Veninga, Tet al. Final results of a prospective study comparing the local control of short course and long course radiotherapy for metastatic spinal cord compression. Int J Radiat Oncol Biol Phys 2011; 79: 524–530.CrossRefGoogle ScholarPubMed
15.Poortmans, P, Vulto, A, Raaijmakers, E. Always on a Friday? Time pattern of referral for spinal cord compression. Acta Oncol 2001; 40: 88–91.Google ScholarPubMed
16.Cox, J D, Stetz, J, Pajak, T F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341–1346.CrossRefGoogle ScholarPubMed
17.Grande, G E, Todd, C J. Why are trials in palliative care so difficult? Pall Med 2000; 14: 69–74.CrossRefGoogle ScholarPubMed
18.Jordhøy, M S, Kaasa, S, Fayers, P, Øvreness, T, Underland, G, Ahlner-Elmqvist, M. Challenges in palliative care research; recruitment, attrition and compliance: experience from a randomised trial. Pall Med 1999; 13: 299–310.CrossRefGoogle Scholar
19.http://clinicaltrials.gov/ct2/show/NCT00968643?term=Spinal+Cord+Compression&rank=1. Accessed on 7th February 2012.Google Scholar
20. Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS, 2006.Google Scholar
21.Kaplan, E L, Meier, P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.CrossRefGoogle Scholar
22.Loblaw, D A, Laperriere, N J, Mackillop, W J. A population-based study of malignant spinal cord compression in Ontario. Clin Oncol 2003; 15: 211–217.CrossRefGoogle ScholarPubMed
23.Lutz, S, Berk, L, Chang, Eet al. Palliative radiotherapy for bone metastasis. Int J Radiat Oncol Biol Phys 2011; 79: 965–976.CrossRefGoogle Scholar
24.Rades, D, Stalpers, L J A, Hulshof, M, Zschenker, O, Alberti, W, Koning, C. Effectiveness and toxicity of single-fraction radiotherapy with 1×8 Gy for metastatic spinal cord compression. Radiother Oncol 2005; 75: 70–73.CrossRefGoogle Scholar
25.Fowler, J F. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 1989; 62: 679–694.CrossRefGoogle ScholarPubMed
26.Tang, V, Harvey, D, Dorsay, J P, Jiang, S, Rathbone, M P. Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning. Spinal Cord 2007; 45: 671–677.CrossRefGoogle ScholarPubMed
27.Glare, P A, Virk, K, Jones, Met al. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ 2003; 327: 195–200.CrossRefGoogle ScholarPubMed
28.Husband, D J, Grant, K A, Romaniuk, C S. MRI in the diagnosis and treatment of suspected malignant spinal cord compression. BJR 2001; 74: 15–23.CrossRefGoogle ScholarPubMed
29.Rades, D, Fehlauer, F, Stalpers, L et al. A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression: final results of a multicenter study. Cancer 2004; 101 (11): 2687–2692.CrossRefGoogle Scholar
30.Patchell, R A, Tibbs, P A, Regine, W Fet al. Direct decompressive surgical resection in the treatment of spinal cod compression caused by metastatic cancer: a randomized trial. Lancet 2005; 266: 643–648.CrossRefGoogle Scholar