Palliative radiotherapy for metastatic malignant melanoma: Brain metastases, bone metastases, and spinal cord compression

1988 ◽  
Vol 15 (4) ◽  
pp. 859-864 ◽  
Author(s):  
William R.Rate ◽  
Lawrence J. Solin ◽  
Andrew T. Turrisi
Keyword(s):  
Spinal Cord ◽  
Malignant Melanoma ◽  
Brain Metastases ◽  
Bone Metastases ◽  
Spinal Cord Compression ◽  
Palliative Radiotherapy ◽  
Metastatic Malignant Melanoma ◽  
Cord Compression ◽  
Melanoma Brain Metastases

Analysis of a neurosurgical directed acute spinal cord compression pathway at Michigan Medicine, a tertiary referral hospital.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18285-e18285
Author(s):  
John C. Krauss ◽  
Daniel Klarr
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Bone Metastases ◽  
Spinal Cord Compression ◽  
Radiation Oncology ◽  
Medical Oncology ◽  
Cord Compression ◽  
Imaging Protocol ◽  
Presenting Symptoms ◽  
Previous Diagnosis

e18285 Background: Spinal cord compression (SCC) is considered an oncologic emergency that is likely to severely impair patients’ quality of life if immediate action is not taken. Clinicians need a high suspicion to diagnose SCC, as the presenting symptoms are variable and nonspecific. To expedite the diagnosis and treatment of SCC, we instituted an emergent spine MRI imaging pathway that was led by the neurosurgeons and involved close collaboration with medical oncology and radiation oncology. Methods: The charts of all patients from July 2015 to June 2018 who underwent the “MR Spine Cord Compression Acute” imaging pathway at Michigan Medicine were reviewed. Electronic time stamps provided the time of the initial order, the time to scan completion, the time to scan reading, and the time to definitive intervention. The charts were reviewed for the initial neurosurgical physical exam, a presentation consistent with recent trauma, a previous diagnosis of malignancy, and a previous diagnosis of bone metastases. The type and timing of therapy, and survival following the imaging protocol were assessed. Results: 319 unique MRI exams were done over the three-year span, 155 of the patients had cancer, and 75 patients had SCC. The time from ordering of exam to performance is 2.91 hours (0 to 25.45), from performance to read 8.31 hours (0 to 75.25 hours). Time from MRI to intervention was 63.14 hours (0 to 432 hours) based on complex decision making around surgical vs. radiation vs. medical therapy. For the majority of patients who were diagnosed with SCC, the cause was secondary to tumor growth from contiguous spinal metastasis, and most had previously identified bone metastases. Degenerative disc extrusion was the most common cause of benign SCC. Conclusions: A neurosurgical directed standard imaging protocol is effective at rapidly diagnosing SCC. Malignant SCC is predominately treated surgically, but complex multi-disciplinary patient centered decision-making involving neurosurgery, radiation oncology, and medical oncology is frequently necessary to arrive at the appropriate treatment.

Primary and Metastatic Central Nervous System Malignancies

2015 ◽  
Author(s):  
Fabio M. Iwamoto ◽  
Howard A. Fine
Keyword(s):  
United States ◽  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Brain Metastases ◽  
Spinal Cord Compression ◽  
The United States ◽  
Cord Compression ◽  
Leptomeningeal Metastases ◽  
Cns Malignancies

About 13,000 deaths each year in the United States are attributed to primary central nervous system (CNS) malignancies. An estimated 20% of patients with cancer eventually develop clinically apparent CNS metastases, and an estimated 170,000 cases of brain metastases are diagnosed in the United States yearly. Autopsy studies suggest that as many as 50% of patients dying from advanced cancer may have metastasis to the CNS. This chapter provides an overview of primary and metastatic CNS malignancies with in-depth discussion of gliomas, primary CNS lymphoma, meningioma, brain metastases, leptomeningeal metastases, and metastatic epidural spinal cord compression. Discussions cover epidemiology, etiology, diagnosis, and treatment of gliomas, including surgery, radiotherapy, and chemotherapy for both newly diagnosed gliomas and recurrent gliomas. The epidemiology, diagnosis, treatment and prognosis for primary CNS lymphomas are reviewed, as well as the epidemiology, etiology, diagnosis, treatment, and prognosis for meningiomas. Epidemiology, diagnosis, and prognosis for brain metastases are briefly discussed, and the section on treatment includes surgery, stereotactic radiosurgery, and whole-brain radiotherapy for patients with three or fewer brain metastases. The sections on leptomeningeal metastases and metastatic epidural spinal cord compression cover diagnosis, treatment, and prognosis. This chapter contains 126 references.

Steroid tapering for patients with spinal cord compression or symptomatic brain metastases at Jackson Memorial Hospital.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 238-238
Author(s):  
David Asher ◽  
Benjamin Farnia ◽  
Stephen Ramey ◽  
Sarah Francis ◽  
Shahil Mehta ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brain Metastases ◽  
Spinal Cord Compression ◽  
Critical Role ◽  
Tertiary Care ◽  
Care Facility ◽  
Cord Compression ◽  
Grand Round ◽  
Use Of Resources ◽  
Practitioner Education

238 Background: Metastases to the spinal column and brain for patients with cancer are common occurrences seen in oncology practices. Steroids play a critical role in symptom management upon patient presentation and proper tapering of steroids is necessary to minimize risk of recurrent symptoms. Within our institution, which is a tertiary care facility primarily for the poor and near-poor of a large urban environment, 78% of patients with spinal cord compression or symptomatic brain metastases do not receive appropriate tapering of steroids following completion of radiation treatment. This leads to unnecessary side effects from continued steroid use, ultimately leading to an inefficient use of resources, including time and money. Methods: Through the guidance of American Society of Clinical Oncology (ASCO) Quality Training Program, we created a process map, cause and effect diagram, and acquired preliminary diagnostic data. This data was acquired via electronic medical record (EMR) review including evaluation of inpatient notes, discharge summaries, medication orders and prescriptions, and outpatient clinic visit notes. We then completed several PDSA cycles including grand round presentation, tapering template incorporation into clinic, and template creation within our EMR. Results: We identified that a single physician primarily was responsible for the patients that appropriately received steroids. We utilized this physician's expertise to help create meaningful interventions. By the complete of our last PDSA cycle, we have reduced the percentage of patients who do not receive an adequate steroid taper form 78% to 20%. Conclusions: Practitioner education and incorporation of steroid tapering templates into an outpatient radiation oncology clinic can reduce the percentage of patients with spinal cord compression or symptomatic brain metastases, who do not receive and adequate steroid tapering regimen.

Design and implementation of outpatient-based rapid MRI protocols to rule out metastatic spinal cord compression and brain metastases.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18307-e18307
Author(s):  
Jessica G. Fried ◽  
Michael Joseph Lariviere ◽  
Ravi Bharat Parikh ◽  
Patricia Zadnik Sullivan ◽  
Genevieve P. Kanter ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brain Metastases ◽  
Median Time ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Final Report ◽  
Inpatient Management ◽  
Ed Visits ◽  
Rapid Mri ◽  
Rule Out

e18307 Background: Metastatic spinal cord compression (MSCC) and symptomatic brain metastases (mets) are potential emergencies that demand coordinated multidisciplinary management. Patients (pts) with concerning symptoms are often referred to the Emergency Department (ED) for expedited imaging, but most do not require subsequent ED or inpatient management. Unnecessary ED visits incur substantial cost to the health system and patients, and cause psychosocial stress for patients often near the end-of-life. To improve access to expedited outpatient imaging for high-risk pts and reduce unnecessary ED visits, we developed outpatient rapid MRI protocols and pathways to rule out MSCC and brain mets. Methods: Tailored abbreviated MRI protocols were developed to allow rapid acquisition of brain ( < 13 minutes) and full spine ( < 25 minutes) exams. Dedicated appointments were reserved on the daily MRI schedule. Exams were immediately interpreted and reported by Radiology to the ordering clinician. This pathway was piloted within the Thoracic Oncology group beginning in 10/2018. Results: Referring specialties included Radiation Oncology (50%), Medical Oncology (36%), Pulmonology (7%), and Surgery (7%). For 6 pts who had outpatient rapid brain imaging, median time from order to exam start was 4.3 h (1.8-31) and order to final report 6.8 h (3.2-34.1). Brain mets were found in 4/6 patients. Only 1/4 positive studies required subsequent ED management. For 8 pts referred for rapid spine imaging, median time from order to exam start was 14.4 h (2.2-72.5) and order to final report 16.7 h (4.0-74.4). Only 1 patient was found to have cord compression and required ED/inpatient management. Overall, 86% of patients did not require ED or inpatient admission. 3 pts (all with negative imaging) died a median 13.4 d (1.4-28.3) after order placement. Conclusions: Outpatient rapid MRI protocols facilitate same-day imaging, interpretation, and management, improving care for thoracic oncology pts with new concerning neurologic symptoms and reducing unnecessary ED visits. Future work will expand access beyond Thoracic Oncology and further quantify improvements in cost savings and patient quality of life.

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

2013 ◽  
Vol 12 (3) ◽  
pp. 218-225
Author(s):  
L. O'Sullivan ◽  
A. Clayton-Lea ◽  
O. McArdle ◽  
M. McGarry ◽  
J. Kenny ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Clinical Symptoms ◽  
Performance Status ◽  
Palliative Radiotherapy ◽  
Neurological Status ◽  
Cord Compression ◽  
Response To Treatment ◽  
Similar Data ◽  
A Prospective Study

AbstractImpending 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.PurposeTo 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 methodsData (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.ResultsThe 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.ConclusionAlthough 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.

scholarly journals Quality Improvement Initiative to Enhance Multidisciplinary Management of Malignant Extradural Spinal Cord Compression

2020 ◽  
Vol 16 (8) ◽  
pp. e829-e834
Author(s):  
Malcolm D. Mattes ◽  
Josiah D. Nieto
Keyword(s):  
Spinal Cord ◽  
Quality Improvement ◽  
Spinal Cord Compression ◽  
Clinical Pathway ◽  
Time Course ◽  
Palliative Radiotherapy ◽  
Multidisciplinary Care ◽  
Cord Compression ◽  
Quality Improvement Initiative ◽  
Multidisciplinary Management

PURPOSE: To determine if a quality improvement (QI) initiative could enhance multidisciplinary management of acute malignant extradural spinal cord compression (ESCC) at our institution. METHODS: The medical records of all 40 patients who received palliative radiotherapy for malignant ESCC from 2015 to 2017 were reviewed to determine the time course of key National Comprehensive Cancer Network guideline–supported workup and management steps. On the basis of the findings, a multidisciplinary group of physician stakeholders developed a clinical pathway to facilitate expedited care. The efficacy of this clinical pathway and the educational content provided to all relevant departments were then evaluated by comparing outcomes with data from a similarly reviewed follow-up cohort of 25 patients from 2018 to 2019. RESULTS: Patients treated for malignant ESCC after our QI intervention were more likely to undergo magnetic resonance imaging (MRI) of the entire spine (64% v 44%; P = .013) and have a radiation oncology (RO) consultation before surgery (100% v 27%; P = .002). Median time from MRI to RO consultation decreased from 3 to 1 days ( P = .03). On subgroup analysis, initial trends toward delays in RO consultation for patients planning for surgery (median, 3 days) or for lack of prior cancer diagnosis (median, 4 days) were reduced to delays of 0 and 1 day, respectively, after the QI intervention. No significant differences were observed in time to surgical consultation or surgery itself. CONCLUSION: This QI study was able to stimulate better use of diagnostic imaging and earlier involvement of RO in multidisciplinary decision making, suggesting an effective approach to improving multidisciplinary care in other scenarios as well.

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