Recurrent spinal epidural metastases: a prospective study with a complete follow up

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 1999-05, Vol.66 (5), p.623-627
• Main Authors: van der Sande, J J, Boogerd, W, Kröger, R, Kappelle, A C
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Breast cancer; Chemotherapy; Epidural; Epidural Space; Female; Follow-Up Studies; Humans; Male; Medical sciences; Metastasis; Middle Aged; multiple spinal epidural metastases; Neurology; Patients; Prospective Studies; Prostate; Radiation therapy; Recurrence; recurrent spinal epidural metastases; spinal cord compression; Spinal Cord Neoplasms - mortality; Spinal Cord Neoplasms - secondary; Spinal Cord Neoplasms - therapy; Surgery; Survival Analysis; Time Factors; Tumors; Tumors of the nervous system. Phacomatoses
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.66.5.623

OBJECTIVES Prospective studies with a complete follow up in patients with spinal epidural metastases (SEM) are rare, so little is known of the incidence and relevance of recurrent spinal epidural metastases (RSEM). This prospective study was undertaken as a part of a previously started and extended prospective study to determine the occurrence and details of RSEM. METHODS Patients with SEM of various primary malignancies were followed up until death. The diagnosis was confirmed after neurological examination by imaging studies visualising not only the clinically suspected level, but also as much of the spinal canal as possible. RESULTS Recurrent spinal epidural metastases (RSEM) occurred in 21 of the 103 patients (20%) after a median interval of 7 months and, after treatment, a second recurrence occurred in 11 patients (11%), a third recurrence in two patients (2%), and a sixth recurrence in one patient (1%). RSEM developed about as often at the initial level (55%) as at a different level (45%), did not occur more often in patients with initially multiple SEM, but, not surprisingly, occurred much more often in patients with longer survival. About one half of the patients surviving 2 years, and nearly all patients surviving 3 years or longer developed RSEM. Ambulatory state could be preserved in most patients, even after their second recurrence. CONCLUSION RSEM are common and even several episodes of RSEM in the same patient are not rare. Patients with SEM who survive long enough have a high risk of RSEM and prompt treatment of RSEM to maintain the ambulatory state of the patient is valuable.