Clinical Analysis Of Metastatic Spinal Cord Compression

Kim, Min Kyoung; Lee, Jae Lyun; Lee, Sang Hee; Shin, Sang Jun; Kim, Kyung Ok; Kim, Yong Gil; Lee, Kyung Hee; Hyun, Myung Soo; Bae, Sung Hwa; Ryoo, Hyun Mo

Abstract

BACKGROUND: Spinal cord compression is a common neurologic complication of advanced cancer and it is a medical emergency because delay in treatment often results in irreversible neurologic dysfunction. We analyzed the clinical characteristics, treatment outcome, favorable factors which affect survival and the result of radiation therapy and surgery.
METHODS
The records of 50 patients with epidural cord compression during the period from January 1994 to December 2003 were reviewed retrospectively.
RESULTS
The most common cause of metastatic spinal cord compression was lung cancer (28%), followed by hepatoma (22%), and colorectal cancer (14%). 44 patients received radiation therapy and 2 patients were treated with surgery. The median survival was 2.9 months irrespective of treatment. The factors which affect survival were initial performance status, radiotherapy and ambulatory function (p<0.05). At diagnosis, 31 (62%) of 50 patients presented with paralytic status. Radiation therapy affected preservation of ambulatory function significantly (p<0.05). Among the patients treated with radiotherapy, 14 of 18 patients who were ambulatory and 5 of 26 paralytic patients before treatment remained ambulatory or became ambulatory (p<0.01). Surgery permitted patients to remain ambulatory, but only 2 patients were received surgery.
CONCLUSION
We confirmed that radiation therapy is effective palliative treatment for patients with epidural cord compression. Initial performance status and ambulatory function were identified as important prognostic factors. Prompt diagnosis and treatment were necessary, if not, neurologic function was not regained in the majority of patients. Indivisualized and more aggressive therapy including surgery should be considered.