Lengthy-Time period Comply with-Up of Sufferers with Metastatic Epidural Spinal Twine Compression from Stable Tumors Submitted for Surgical procedure Adopted by Radiation Remedy.
World Neurosurg. 2018 Jul;115:e681-e687
Authors: Pessina F, Navarria P, Carta GA, D’Agostino GR, Clerici E, Nibali MC, Costa F, Fornari M, Scorsetti M
OBJECTIVE: To guage the end result of sufferers with epidural spinal twine compression from totally different stable tumors handled with a mixed strategy, surgical procedure plus radiotherapy (RT), with a follow-up longer than 10 years.
METHODS: Ninety-seven sufferers handled between 2002 and 2009 have been included. Surgical remedy was carried out in sufferers with good efficiency standing, restricted metastatic illness, life expectancy longer than three months, and progressive neurologic deficit and/or intractable ache. RT was carried out delivering a median whole dose of 30 Gy in 10 fractions. Medical end result was evaluated utilizing the modified visible analog scale for ache, the Frankel scale for neurologic deficit, and magnetic resonance imaging earlier than remedy, after remedy, and each three months thereafter.
RESULTS: Palliative decompression was carried out in 27% of sufferers, tumor curettage (debulking) was carried out in 51%, and whole vertebrectomy was carried out in 22%, adopted by RT in 78% of circumstances. Ache remission was obtained in 98% of sufferers, and restoration of neurologic operate was obtained in 51%. The median follow-up time was 135 months (vary, 96-209 months). The 5- and 10-year native management charges have been 82.eight% and 82.eight%, respectively. The median and 5- and 10-year progression-free survival charges have been 12 months, 16.9%, and 11.three%, respectively; the median and 5- and 10-year total survival charges have been 18 months, 21.three%, and 12%, respectively. On univariate and multivariate evaluation, components recorded as conditioning survival have been the efficiency standing and the presence of different metastases on the time of vertebral remedy (P < zero.01).
CONCLUSIONS: Our replace confirmed that surgical procedure plus RT is a protected and possible remedy with restricted morbidity. In chosen sufferers with favorable prognostic components, the mixed remedy could considerably impression on survival.
PMID: 29709741 [PubMed – indexed for MEDLINE]