Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

Study Design: Narrative review. Objective: Metastatic spinal cord compression (MSCC) is a very frequent complication among cancer patients. Presenting commonly as nocturnal back pain, MSCC typically progresses to lower extremity paresis, loss of ambulatory capabilities, and paraplegia. In addition to standard treatment modalities, corticosteroid administration has been utilized in preclinical and clinical settings as adjunctive therapy to reduce local spinal cord edema and improve clinical symptoms. This article serves as a review of existing literature regarding corticosteroid management of MSCC and seeks to provide potential avenues of research on the topic. Methods: A literature search was performed using PubMed in order to consolidate existing information regarding dexamethasone treatment of MSCC. Of all search results, 7 articles are reviewed, establishing the current understanding of metastatic spine disease and dexamethasone treatment in both animal models and in clinical trials. Results: Treatment with high-dose corticosteroids is associated with an increased rate of potentially serious systemic side effects. For this reason, definitive guidelines for the use of dexamethasone in the management of MSCC are unavailable. Conclusions: It is still unclear what role dexamethasone plays in the treatment of MSCC. It is evident that new, more localizable therapies may provide more acceptable treatment strategies using corticosteroids. Looking forward, the potential for more targeted, localized application of the steroid through the use of nanotechnology would decrease the incidence of adverse effects while maintaining the drug’s efficacy.

Download Full-text

Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression

Neurology ◽

10.1212/wnl.39.9.1255 ◽

1989 ◽

Vol 39 (9) ◽

pp. 1255-1255 ◽

Cited By ~ 176

Author(s):

Ch. J. Vecht ◽

H. Haaxma-Reiche ◽

W. L. J. van Putten ◽

M. d. Visser ◽

E. P. Vries ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

High Dose ◽

High Dose Dexamethasone ◽

Initial Bolus

Download Full-text

The potential role of modern radiotherapy techniques in the treatment of malignant spinal cord compression: a dose planning study

Journal of Radiotherapy in Practice ◽

10.1017/s1460396915000400 ◽

2015 ◽

Vol 14 (4) ◽

pp. 418-424 ◽

Cited By ~ 2

Author(s):

Lotte S. Fog ◽

Deborah Schut ◽

Per Sjøgren ◽

Marianne C. Aznar

Keyword(s):

Spinal Cord ◽

Radiation Therapy ◽

Dose Reduction ◽

Spinal Cord Compression ◽

Cord Compression ◽

Treatment Modalities ◽

High Dose ◽

Lumbar Region ◽

Field Technique ◽

Time Required

AbstractAimTo investigate the doses given to the kidneys and the small intestines for three radiation therapy techniques [anterior–posterior (APPA) fields, three fields and volumetric-modulated arc therapy (VMAT)] for spinal cord compression (SCC) patients with metastatic disease in the lower thoracic or lumbar spine and to monitor the time spent by clinicians and dose planners.IntroductionRadiation therapy is one of the main treatment modalities for SCC. Typical palliative radiation therapy techniques have used APPA fields or a three-field technique.However, as delivery techniques have evolved dramatically over the past decades, VMAT has gained wide acceptance. VMAT allows for a dose reduction in the organs at risk. Such a dose reduction may result in less toxicity.The use of the VMAT technique may require more time for contouring and planning compared with the APPA and three-field techniques. Any potential dosimetric benefit of VMAT must not be outweighed by large amounts of extra time spent by clinicians and dose planners.Materials and methodsFor 20 patients treated with radiation therapy for SCC at our hospital, we created a VMAT plan, and the more traditionally used APPA and three-field plans. The mean kidney doses and the volume of bowel, which received 20 Gy, were extracted for each plan. The correlations between parameters for three techniques were determined.Furthermore, the time required for contouring targets for five patients; and the time required to plan five patients, was recorded.ResultsVMAT lead to the most conformal distributions: the high-dose areas were restricted to the target volume, whereas the healthy tissue, especially the bowel, received a lower dose. In contrast, the APPA plan lead to a larger volume of bowel being irradiated, whereas the three-field technique spared the bowel at the expense of a higher dose to the kidneys.The average contouring time was 16 minutes, the average planning time was 38 minutes.ConclusionPatients treated for SCC in the lower thoracic or lumbar region may benefit from VMAT treatment, as it reduces the dose to the bowel and kidneys compared with APPA or three-field treatments.

Download Full-text

High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression

Journal of Neuro-Oncology ◽

10.1007/bf00172664 ◽

1992 ◽

Vol 12 (2) ◽

Cited By ~ 95

Author(s):

Ketil Heimdal ◽

Henry Hirschberg ◽

Haldor Sletteb� ◽

Kjell Watne ◽

Ole Nome

Keyword(s):

Spinal Cord ◽

Side Effects ◽

Spinal Cord Compression ◽

Cord Compression ◽

High Dose ◽

Dexamethasone Treatment ◽

High Dose Dexamethasone ◽

High Incidence

Download Full-text

Metastatic Spinal Cord Compression

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2005.0041 ◽

2005 ◽

Vol 3 (5) ◽

pp. 711-719 ◽

Cited By ~ 22

Author(s):

Meic H. Schmidt ◽

Paul Klimo ◽

Frank D. Vrionis

Keyword(s):

Spinal Cord ◽

Cancer Patients ◽

Spinal Cord Compression ◽

Radiation Treatment ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Treatment Modalities ◽

Survival Times ◽

Patients With Cancer

Approximately 70% of cancer patients have metastatic disease at death. The spine is involved in up to 40% of those patients. Spinal cord compression may develop in 5% to 10% of cancer patients and up to 40% of patients with preexisting nonspinal bone metastasis (>25,000 cases/y). Given the increasing survival times of patients with cancer, greater numbers of patients are likely to develop this complication. The role of surgery in the management of metastatic spinal cord compression is expanding. The management of metastatic spine disease can consist of a combination of surgery, radiation treatment, and chemotherapy. Treatment modalities are not mutually exclusive and must be individualized for patients evaluated in a multidisciplinary setting.

Download Full-text

Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial

European Journal of Cancer ◽

10.1016/s0959-8049(05)80011-5 ◽

1994 ◽

Vol 30 (1) ◽

pp. 22-27 ◽

Cited By ~ 231

Author(s):

P.S. Sørensen ◽

S. Helweg-Larsen ◽

H. Mouridsen ◽

H.H. Hansen

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Randomised Trial ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

High Dose ◽

High Dose Dexamethasone

Download Full-text

Glucocorticoid-induced diabetes in patients with metastatic spinal cord compression

Endocrine Connections ◽

10.1530/ec-18-0088 ◽

2018 ◽

Vol 7 (5) ◽

pp. 719-726 ◽

Cited By ~ 2

Author(s):

Helga Schultz ◽

Svend Aage Engelholm ◽

Eva Harder ◽

Ulrik Pedersen-Bjergaard ◽

Peter Lommer Kristensen

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Plasma Glucose ◽

Time Course ◽

Daily Basis ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

High Dose ◽

Baseline Hba1c ◽

Observational Cohort

Background The risk of developing diabetes mellitus (DM) during treatment with high-dose glucocorticoids is unknown and monitoring of glucose is random in many settings. Objective To determine incidence of and risk factors for induction of DM during high-dose glucocorticoid therapy of metastatic spinal cord compression (MSCC) in patients referred to radiotherapy. Furthermore, to describe the time course of development of DM. Subjects and methods 140 patients were recruited (131 were included in the analysis) with MSCC receiving high-dose glucocorticoid ≥100 mg prednisolone per day were included in a prospective, observational cohort study. The primary endpoint was development of DM defined by two or more plasma glucose values ≥11.1 mmol/L. Plasma glucose was monitored on a daily basis for 12 days during radiotherapy. Results Fifty-six of the patients (43%; 95% CI 35–52%) were diagnosed with DM based on plasma glucose measurements during the study period. Sixteen patients, 12% (95% CI 6–18%), were treated with insulin. At multivariate analysis, only high baseline HbA1c predicted the development of insulin-treated DM. An HbA1c-value <39 mmol/mol was associated with a negative predictive value of 96% for not developing DM needing treatment with insulin. The diagnosis of diabetes with need for insulin treatment was made within 7 days in 14 of the 16 (88%; 95% CI 72–100%) patients. Conclusion The risk of developing DM during treatment with high-dose glucocorticoids in patients with MSCC referred to radiotherapy is high in the first treatment week. Only referral HbA1c predicts the development of DM.

Download Full-text