Abstract
Radiotherapy alone is the most common treatment for metastatic epidural spinal cord compression (MESCC). Decompressive surgery followed by radiotherapy is generally indicated only in 10–15% of MESCC cases. Chemotherapy has an unclear role and may be considered for selected patients with hematological or germ-cell malignancies. If radiotherapy alone is given, it is important to select the appropriate regimen. Similar functional outcomes can be achieved with short-course radiotherapy regimens and longer-course radiotherapy regimens. Longer-course radiotherapy is associated with better local control of MESCC than short-course radiotherapy. Patients with a more favorable survival prognosis (expected survival of ≥6 months) should receive longer-course radiotherapy, as they may live long enough to develop a recurrence of MESCC. Patients with an expected survival of <6 months should be considered for short-course radiotherapy. A recurrence of MESCC in the previously irradiated region after short-course radiotherapy may be treated with another short-course of radiotherapy. After primary administration of longer-course radiotherapy, decompressive surgery should be performed if indicated. Alternatively, re-irradiation can be performed using high-precision techniques to reduce the cumulative dose received by the spinal cord. Larger prospective trials are required to better define the appropriate treatment for the individual patient.
Key Points
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Radiotherapy alone is the most common treatment modality for metastatic epidural spinal cord compression (MESCC), whereas decompressive surgery is indicated only for 10–15% of patients with MESCC
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Short-course radiotherapy regimens are as effective as longer-course radiotherapy regimens with respect to post-treatment motor function; however, longer-course radiotherapy confers better local control of MESCC than short-course radiotherapy
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Patients with a poor expected survival should receive short-course radiotherapy, and those patients with a relatively favorable prognosis should receive longer-course radiotherapy or even high-precision radiotherapy
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Whenever possible, radiotherapy should be supplemented by administration of dexamethasone at an intermediate dose level with a tapered dose during or immediately after completion of radiotherapy
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A recurrence of MESCC in the previously irradiated region after short-course radiotherapy may be treated with another short-course of radiotherapy
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After primary administration of longer-course radiotherapy, decompressive surgery or, alternatively, re-irradiation with high-precision techniques should be performed for recurrence
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D. Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
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D. Rades and J. L. Abrahm contributed equally to the literature review and writing of this manuscript.
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D. Rades declares he is on the speaker's bureau and is an Advisory Board member/consultant for Amgen and Astra Zeneca, and is also on the speaker's bureau and receives grant/research support from Novartis and Merck Serono. J. L. Abrahm declares she is on the speaker's bureau for Janssen–Cilag, Merck, Ortho Biotech and Purdue Pharma.
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Rades, D., Abrahm, J. The role of radiotherapy for metastatic epidural spinal cord compression. Nat Rev Clin Oncol 7, 590–598 (2010). https://doi.org/10.1038/nrclinonc.2010.137
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DOI: https://doi.org/10.1038/nrclinonc.2010.137
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