Clinical StudySurgical results of metastatic spinal cord compression (MSCC) from non–small cell lung cancer (NSCLC): analysis of functional outcome, survival time, and complication
Introduction
Lung cancer is one of the leading causes of cancer-related death in men and women in the United States and accounts for approximately 20% of metastatic spinal cord compression (MSCC) [1], [2], [3]. Despite recent improvements in medical therapy, the prognosis of advanced lung cancer remains poor, with an expected survival time of less than 6 months [1], [4]. Thus, non-surgical treatments, such as radiotherapy with or without corticosteroids, have been preferred as first-line therapeutic modalities for the treatment of spinal metastases from lung cancer [5]. However, urgent surgical decompression is frequently required in patients with acute neurologic deterioration due to MSCC. Recent studies have proven that direct decompression surgery followed by radiation therapy is superior to radiation therapy alone for the treatment of MSCC [6], [7], [8]. Nonetheless, in the case of lung cancer, we tend not to recommend the surgical treatment even for acute neurologic deficit because of fear of short life expectancy and the potential risk of complications.
A number of studies have reported favorable surgical results for metastatic spinal tumors from various solid tumors [9], [10], [11], [12], [13]. However, to the best of our knowledge, few studies have focused on surgical treatment of MSCC from lung cancer despite its frequency. In the present study, we aimed to present the functional outcomes, survival time, and complications after surgical treatment for MSCC from non–small cell lung cancer (NSCLC) to provide information for decision making in this subgroup of patients.
Section snippets
Materials and methods
We prospectively followed up 50 NSCLC patients who underwent surgical treatment for acute or subacute neurologic deficit due to MSCC between March 2010 and June 2014. All patients were assessed using the same protocol to evaluate the oncological and functional status pre- and postoperatively. We only included subjects who presented with neurologic impairments, and excluded patients who had only axial pain without any neurologic deficit because the surgery might not be essential for these
Results
The study cohort consisted of 27 males and 23 females with a mean age of 58.0±11.3 years (range: 26.0–79.0) at the time of surgery. The mean time from development of neurologic deficit to surgery was 85.4±52.3 hours (range: 18.0–216.0). The thoracic spine was the most affected vertebrae, and posterior corpectomy followed by posterior fixation were the most common procedures (Table 1). Histology revealed adenocarcinoma in 27 patients and squamous cell carcinoma in 23 patients. The interval
Discussion
Non–small cell lung cancer is a quite common cancer and accounts for approximately 20% of all patients presenting with MSCC [2], [3]. Patients with MSCC from NSCLC have a worse prognosis compared with those with MSCC from other tumors, such as breast cancer, prostate cancer, and melanoma [3], [16], [17]. Recently, decompression surgery with or without radiotherapy has been considered the gold standard for MSCC treatment with good results [6], [7], [9], [10], [11], [12], [17]. Unfortunately, few
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Author disclosures: SJP: Nothing to disclose. CSL: Nothing to disclose. SSC: Nothing to disclose.