Radiation therapy of metastatic spinal cord compression : Multidisciplinary team diagnosis and treatment

• Published in: Journal of neuro-oncology 1999-03, Vol.42 (1), p.85-92
• Main Authors: KOVNER, F, SPIGEL, S, CHAITCHIK, S, INBAR, M, RIDER, I, OTREMSKY, I, RON, I, SHOHAT, E, RABEY, J. M, AVRAM, J, MERIMSKY, O, WIGLER, N
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Breast Neoplasms - pathology; Diseases of the nervous system; Female; Humans; Lung Neoplasms - pathology; Male; Medical sciences; Middle Aged; Pain; Patient Care Team; Prostatic Neoplasms - pathology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Spinal Cord Compression - diagnosis; Spinal Cord Compression - etiology; Spinal Cord Compression - radiotherapy; Spinal Cord Neoplasms - diagnosis; Spinal Cord Neoplasms - radiotherapy; Spinal Cord Neoplasms - secondary; Tropical medicine
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1023/A:1006124724858

To evaluate the effectiveness of a multidisciplinary approach to spinal cord compression (SCC) in accordance with prospective protocol, providing a uniform approach to diagnosis, decision making concerning optimal treatment modality in any particular case of SCC, treatment performance and evaluation of treatment results. The SCC patients treated by radiation therapy are described. Patients with SCC were examined and treated by a multidisciplinary team consisting of a neurologist, radiologist, oncologist, orthopedic surgeon, and neurosurgeon. Seventy-nine patients for whom radiation was recommended received a 30 Gy radiation dose to a compression-causing mass and course of high dose dexamethasone. Three fractions of 5 Gy and 5 fractions 3 Gy each were delivered by Co60 or 8 MV photon beam in 12 days. Treatment outcome was essentially evaluated by ambulation capabilities which were considered to be the main problem of SCC. Changes in other neurologic motor, sensory and autonomic disturbances were also evaluated. Seventy-two percent of the patients were already non-ambulatory at diagnosis. The first symptom was motor deficiency in only 33% of them while in all other cases it was pain. Ambulation capability was the main prognosticator of treatment outcome; 90% of patients who were ambulatory before treatment remained so while 33% of the non-ambulatory patients regained their ability to walk. The grade of motor disturbance was also an important variable: among the non-ambulatory patients, 50% of the paretic but only 14% of the plegic ones became ambulatory. Overall, 51% of the study patients were ambulatory after undergoing radiation. The ambulatory state after treatment was the main predictor for survival. Close cooperation of a multidisciplinary team in diagnosis and treatment according to the above protocol enabled the achievement of good results of radiation treatment in SCC. Early diagnosis and early treatment should further enhance therapeutic outcome.