scholarly journals Metastatic Spinal Cord Compression as the First Manifestation of Malignancy – A Retrospective Study of Surgical Outcome from Single Institution Spine Tumor Registry

2021 ◽  
Author(s):  
Ue-Cheung Ho ◽  
Dar-Ming Lai ◽  
Fu-Ren Xiao ◽  
Shih-Hung Yang ◽  
Chang-Mu Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Spinal Cord Compression ◽  
Surgical Outcome ◽  
Progression Free Survival ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Duration Of Symptoms ◽  
Free Survival ◽  
Significant Difference

Abstract Given the limited studies addressing the issue about the effect of different surgical modalities for metastatic spinal cord compression (MSCC) as the first malignancy manifestation, we conducted a retrospective case-control study to evaluate the surgical outcome of MSCC as the first malignancy manifestation. A total of 59 patients who were suspected of having metastatic spinal cord compression and underwent surgery from 2008 to 2017 were enrolled in the study. All patients were categorized into either ‘debulking group’ or ‘palliative group’. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), Frankel scale, and Karnofsky scores. All the outcomes were analyzed with a data cutoff of December 31, 2017. There was a significant difference between groups in progression-free survival (PFS) (p = 0.0036). However, there was no significant difference between groups in the overall survival (OS) (p = 0.8669). Age of onset, gender, duration of symptoms, and location of spinal metastasis, initial Frankel, initial Tomita scores, and initial Karnofsky performance scale showed no significant differences between groups. In conclusion, debulking surgery was shown to provide better neurological recoveries and could be considered first in patients with metastatic spinal cord compression as the first malignancy manifestation.

A new and simple scoring system to predict overall survival after irradiation for metastatic spinal cord compression

2019 ◽  
Vol 22 (3) ◽  
pp. 440-444
Author(s):  
P. Nenclares ◽  
S. Guardado ◽  
L. Asiáin ◽  
M. Á. Pérez-Escutia ◽  
M. C. Peña ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Spinal Cord Compression ◽  
Scoring System ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression

Metastatic spinal cord compression secondary to lung cancer.

1992 ◽  
Vol 10 (11) ◽  
pp. 1781-1787 ◽  
Author(s):  
F Bach ◽  
N Agerlin ◽  
J B Sørensen ◽  
T B Rasmussen ◽  
P Dombernowsky ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Cell Carcinoma ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Rank Test ◽  
Log Rank Test ◽  
Significant Difference ◽  
Histologic Types

PURPOSE Metastatic spinal cord compression (MSCC) is a disabling complication to cancer, the optimal treatment for which is not settled. An analysis was performed for all patients with MSCC secondary to lung cancer in East Denmark from 1979 to 1988. PATIENTS AND METHODS The total series included 102 cases with small-cell carcinoma (SCLC; 40%), adenocarcinoma (ACL; 26%), squamous cell carcinoma (SQLC; 18%) and large-cell carcinoma (LCC; 9%). Symptoms, clinical presentations, and therapeutic results are described. RESULTS The outcome of treatment depended fundamentally on the patient's neurologic condition at the time of the diagnosis. All patients with SCLC who were able to walk at the time of MSCC remained ambulatory, whereas 15% of the nonambulatory SCLC patients regained walking ability. In non-SCLC, 95% of patients continued to be able to walk, whereas 22% regained the ability to walk. No major differences in the immediate outcome of treatment between the various histologic types of lung cancer and the different treatment modalities were observed; however, 82% of the patients with non-SCLC benefited from treatment with laminectomy followed by radiotherapy (RT) compared with either laminectomy (47%) or RT (39%) alone (P = .03, chi 2 test). The group of patients who were treated with laminectomy followed by RT had a better survival (median value, 3.5; range, 0 to 132 months) than patients who were treated with either laminectomy (median value, 1.5; range, 0 to 32 months) or RT (median value, 1; range, 0 to 59 months) alone (P = .03, log-rank test). No significant difference was observed in survival between the various histologic types of lung cancer (P = .18, log-rank test). CONCLUSION Despite a short survival, early diagnosis and immediate treatment is crucial because it may preserve the gait function in 97% of lung cancer patients who develop malignant spinal cord compression.

scholarly journals Radiotherapy for metastatic spinal cord compression with increased radiation doses (RAMSES-01): a prospective multicenter study

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dirk Rades ◽  
Olfred Hansen ◽  
Lars Henrik Jensen ◽  
Liesa Dziggel ◽  
Christian Staackmann ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Sensory Function ◽  
Radiation Doses ◽  
Conventional Radiotherapy ◽  
Precision Radiotherapy

Abstract Background Patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses can benefit from radiation doses greater than 30Gy in 10 fractions in terms of improved local progression-free survival (LPFS) and overall survival (OS). Methods/design This prospective study mainly investigates LPFS after precision radiotherapy (volumetric modulated arc therapy or stereotactic body radiotherapy) with 18 × 2.33Gy in 3.5 weeks. LPFS is defined as freedom from progression of motor deficits during radiotherapy and an in-field recurrence of MSCC following radiotherapy. The maximum relative dose allowed to the spinal cord is 101.5% of the prescribed dose, resulting in an equivalent dose in 2Gy-fractions (EQD2) for radiation myelopathy is 45.5Gy, which is below the tolerance dose of 50Gy according to the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC). The EQD2 of this regimen for tumor cell kill is 43.1Gy, which is 33% higher than for 30Gy in 10 fractions (EQD2 = 32.5Gy). Primary endpoint is LPFS at 12 months after radiotherapy. Secondary endpoints include the effect of 18 × 2.33Gy on motor function, ambulatory status, sensory function, sphincter dysfunction, LPFS at other follow-up times, overall survival, pain relief, relief of distress and toxicity. Follow-up visits for all endpoints will be performed directly and at 1, 3, 6, 9 and 12 months after radiotherapy. A total of 65 patients are required for the prospective part of the study. These patients will be compared to a historical control group of at least 235 patients receiving conventional radiotherapy with 10x3Gy in 2 weeks. Discussion If precision radiotherapy with 18 × 2.33Gy results in significantly better LPFS than 10x3Gy of conventional radiotherapy, this regimen should be strongly considered for patients with MSCC and favorable survival prognoses. Trial registration Clinicaltrials.gov NCT04043156. Registered 30-07-2019.

Short-Course Versus Split-Course Radiotherapy in Metastatic Spinal Cord Compression: Results of a Phase III, Randomized, Multicenter Trial

2005 ◽  
Vol 23 (15) ◽  
pp. 3358-3365 ◽  
Author(s):  
Ernesto Maranzano ◽  
Rita Bellavita ◽  
Romina Rossi ◽  
Verena De Angelis ◽  
Alessandro Frattegiani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Response Duration ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Phase Iii ◽  
Bladder Function ◽  
Short Course ◽  
Significant Difference ◽  
Grade 3

Purpose Hypofractionated radiotherapy (RT) is often used in the treatment of metastatic spinal cord compression (MSCC). This randomized trial was planned to assess the clinical outcome and toxicity of two different hypofractionated RT regimens in MSCC. Patients and Methods Three hundred patients with MSCC were randomly assigned to a short-course RT (8 Gy × 2 days) or to a split-course RT (5 Gy × 3; 3 Gy × 5). Only patients with a short life expectancy entered the protocol. Median follow-up was 33 months (range, 4 to 61 months). Results A total of 276 (92%) patients were assessable; 142 (51%) treated with the short-course and 134 (49%) treated with the split-course RT regimen. There was no significant difference in response, duration of response, survival, or toxicity found between the two arms. When short- versus split-course regimens were compared, after RT 56% and 59% patients had back pain relief, 68% and 71% were able to walk, and 90% and 89% had good bladder function, respectively. Median survival was 4 months and median duration of improvement was 3.5 months for both arms. Toxicity was equally distributed between the two arms: grade 3 esophagitis or pharyngitis was registered in four patients (1.5%), grade 3 diarrhea occurred in four patients (1.5%), and grade 3 vomiting or nausea occurred in 10 patients (6%). Late toxicity was never recorded. Conclusion Both hypofractionated RT schedules adopted were effective and had acceptable toxicity. However, considering the advantages of the short-course regimen in terms of patient convenience and machine time, it could become the RT regimen of choice in the clinical practice for MSCC patients.

Prognostic Discrepancy on Overall Survival Between Ambulatory and Nonambulatory Patients with Metastatic Spinal Cord Compression

2019 ◽  
Vol 121 ◽  
pp. e322-e332 ◽  
Author(s):  
Jiang-tao Feng ◽  
Xiong-gang Yang ◽  
Feng Wang ◽  
Kun-chi Hua ◽  
Yong-heng Liu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression

Radiotherapy With 4 Gy × 5 Versus 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression: Final Results of the SCORE-2 Trial (ARO 2009/01)

2016 ◽  
Vol 34 (6) ◽  
pp. 597-602 ◽  
Author(s):  
Dirk Rades ◽  
Barbara Šegedin ◽  
Antonio J. Conde-Moreno ◽  
Raquel Garcia ◽  
Ana Perpar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Motor Function ◽  
Progression Free Survival ◽  
Cord Compression ◽  
Motor Deficits ◽  
Free Survival ◽  
Ambulatory Status ◽  
Local Progression ◽  
Short Course

Purpose To compare short-course radiotherapy (RT) (4 Gy × 5) to longer-course RT (3 Gy × 10) for metastatic epidural spinal cord compression (MESCC). Patients and Methods Two-hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy × 5 in 1 week (n = 101) or 3 Gy × 10 in 2 weeks (n = 102). Patients were stratified according to ambulatory status, time developing motor deficits, and primary tumor type. Seventy-eight and 77 patients, respectively, were evaluable for the primary end point, 1-month overall response regarding motor function defined as improvement or no further progression of motor deficits. Other study end points included ambulatory status, local progression-free survival, and overall survival. End points were evaluated immediately after RT and at 1, 3, and 6 months thereafter. Results At 1 month, overall response rates regarding motor function were 87.2% after 4 Gy × 5 and 89.6% after 3 Gy × 10 (P = .73). Improvement rates were 38.5% and 44.2%, respectively, no further progression rates 48.7% and 45.5%, respectively, and deterioration rates 12.8% and 10.4%, respectively (P = .44). Ambulatory rates at 1 month were 71.8% and 74.0%, respectively (P = .86). At other times after RT, the results were also not significantly different. Six-month local progression-free survival was 75.2% after 4 Gy × 5 and 81.8% after 3 Gy × 10 (P = .51); 6-month overall survival was 42.3% and 37.8% (P = .68). Conclusion Short-course RT with 4 Gy × 5 was not significantly inferior to 3 Gy × 10 in patients with MESCC and poor to intermediate expected survival.

scholarly journals Evaluation of efficacy and toxicity of nivolumab combined with or without docetaxel in patients with advanced NSCLC

2021 ◽  
Author(s):  
Yang Wang ◽  
Jun Nie ◽  
Ling Dai ◽  
Weiheng Hu ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Advanced Nsclc ◽  
Objective Response ◽  
Progression Free Survival ◽  
Meaningful Improvement ◽  
Free Survival ◽  
Significant Difference ◽  
Grade 3 ◽  
Doublet Chemotherapy ◽  
Platinum Doublet

Abstract Background The combination of PD-1/PD-L1 inhibitor and chemotherapy has been clinically confirmed to be beneficial as the first-line treatment of patients with advanced NSCLC. This study aimed to assess the effect of nivolumab + docetaxel versus nivolumab monotherapy in patients with NSCLC after the failure of platinum doublet chemotherapy. Materials and methods The efficacy and toxicity of nivolumab + docetaxel combination therapy versus nivolumab monotherapy were compared in this retrospective study. Primary endpoint of the study was progression-free survival (PFS), and the secondary endpoints were objective response rate (ORR), overall survival (OS), and toxicity. Results Between November 2017 and December 2019, 77 patients were included in this study, with 58 patients in the nivolumab group and 19 in the nivolumab + docetaxel group. The median follow-up was 18 months, and the PFS was 8 months for patients receiving nivolumab + docetaxel and 2 months for those receiving nivolumab alone (p = 0.001), respectively. Nivolumab + docetaxel showed superior OS compared with nivolumab, with the median OS unreached versus 7 months (p = 0.011). Among patients without EGFR/ALK variation, compared to nivolumab monotherapy, nivolumab + docetaxel showed better PFS (p = 0.04) and OS (p  = 0.05). There was no significant difference in grade 3–4 adverse events (AEs) between the two groups (p = 0.253). Conclusions The combination of nivolumab and docetaxel demonstrated a meaningful improvement in progression-free survival and overall survival compared to nivolumab monotherapy, in patients with NSCLC after the failure of platinum doublet chemotherapy, irrespective of EGFR/ALK variation status.

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