Lengthy-Time period Comply with-Up of Sufferers with Metastatic Epidural Spinal Twine Compression from Breast Most cancers Handled with Surgical procedure Adopted by Radiotherapy.
World Neurosurg. 2018 Feb;110:e281-e286
Authors: Pessina F, Navarria P, Riva M, Franceschini D, Nibali MC, Fornari M, Scorsetti M
OBJECTIVE: To guage position of surgical procedure plus radiotherapy (RT) in sufferers with metastatic epidural spinal wire compression from breast most cancers with a follow-up >10 years.
METHODS: The examine included 23 sufferers handled between 2004 and 2008. Surgical therapy was carried out in sufferers with good efficiency standing, restricted metastatic illness, and progressive neurologic deficit and/or intractable ache. RT was carried out delivering a median complete dose of 30 Gy in 10 fractions. Scientific end result was evaluated utilizing the modified visible analog scale for ache, Frankel grade for neurologic deficit, and magnetic resonance imaging earlier than and after remedies and each three months thereafter.
RESULTS: Minimal resection was carried out in 17.four% of sufferers, curettage in 47.eight%, and complete tumorectomy in 34.eight%, adopted by RT in 78.three%. Ache remission was obtained in 98% of sufferers, and restoration of neurologic perform was obtained in 92.9%. Median follow-up time was 153 months (vary, 128-209 months). No relapse at web site of remedies occurred. Median total survival time was 47 months (95% confidence interval 33-114 months), and 2-, 5-, and 10-year total survival charges had been 81% (±eight.6%), 42.9% (±10.eight%), and 28.6% (±9.9%). On univariate evaluation, efficiency standing, kind of surgical resection, breast most cancers phenotype, and presence of different bone metastases had been recorded as influencing survival; the last-mentioned was additionally confirmed in multivariate evaluation.
CONCLUSIONS: Surgical procedure plus RT is a secure and possible therapy with restricted morbidity. In chosen sufferers with good efficiency standing, constructive hormonal receptors, and restricted metastatic illness, surgical intervention ought to be strongly thought of early on.
PMID: 29113903 [PubMed – indexed for MEDLINE]