Radiosurgical decompression of metastatic epidural compression

• Published in: Cancer 2010-05, Vol.116 (9), p.2250-2257
• Main Authors: Ryu, Samuel, Rock, Jack, Jain, Rajan, Lu, Mei, Anderson, Joseph, Jin, Jian‐Yue, Rosenblum, Mark, Movsas, Benjamin, Kim, Jae Ho
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cerebrospinal fluid. Meninges. Spinal cord; decompressive radiosurgery; Epidural Neoplasms - complications; Epidural Neoplasms - secondary; Epidural Neoplasms - surgery; Female; Gait Disorders, Neurologic - surgery; Humans; Male; Medical sciences; metastatic epidural compression; Middle Aged; Nervous system (semeiology, syndromes); Nervous System - physiopathology; Neurology; Radiosurgery; spinal cord compression; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; spine radiosurgery; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.24993

BACKGROUND: Surgical decompression of metastatic epidural compression (MEC) improved ambulatory function. Spine radiosurgery can accurately target the epidural tumor and deliver high radiation doses for tumor control. Therefore, a clinical trial was performed to quantitatively determine the degree of epidural decompression by radiosurgery of metastatic epidural compression. METHODS: Sixty‐two patients with a total of 85 lesions of metastatic epidural compression were treated. Epidural compression was diagnosed by magnetic resonance imaging (MRI) scans. Main criteria of inclusion were neurological status with muscle power 4 of 5 or better. Radiosurgery was performed to the involved spine segment, including the epidural mass with median dose of 16 Gy (range 12‐20 Gy) in a single session. All patients had prospective clinical follow‐up, ranging from 1‐48 months (median 11.5 months), and 36 patients had pretreatment and post‐treatment imaging, ranging from 2‐33 months (median 9.3 months). Primary endpoints were epidural tumor control and thecal sac decompression. RESULTS: The mean epidural tumor volume reduction was 65 ± 14% at 2 months after radiosurgery. The epidural tumor area at the level of the most severe spinal cord compression was 0.82 ± 0.08 cm2 before radiosurgery and 0.41 ± 0.06 cm2 after radiosurgery (P < .001). Thecal sac patency improved from 55 ± 4% to 76 ± 3% (P < .001). Overall, neurological function improved in 81%. CONCLUSIONS: This study demonstrated a radiosurgical decompression of epidural tumor. Although neurosurgical decompression and radiotherapy is the standard treatment in patients with good performance, radiosurgical decompression can be a viable noninvasive treatment option for malignant epidural compression. Cancer 2010. © 2010 American Cancer Society. Epidural decompression was achieved by spine radiosurgery of malignant epidural spinal cord compression. More than 80% of the patients with epidural compression showed radiographic improvement of thecal sac patency and neurological improvement or preservation.