medigraphic.com
Colegio de Medicina Interna de México.

2022, Number 3

<< Back Next >>

Med Int Mex 2022; 38 (3)

Spinal cord compression in cancer patients

Soriano-Lorenzo J, Rojas-Argüelles P, Pons-Leyva D, González-Rojas D, Leyva-Coll G

Language: Spanish
References: 45
Page: 606-616
PDF size: 205.09 Kb.


ABSTRACT

Spinal cord compression syndrome is defined as the symptoms and signs produced by compression of the spinal cord or nerve roots that form the cauda equina due to any lesion related to underlying neoplastic disease. It is the second most frequent neurological complication in cancer patients after brain metastases. It is estimated that it affects approximately 5% of cancer patients. It occurs mainly as a complication in patients affected by lung, breast, prostate cancer and multiple myeloma. Spinal cord compression syndrome is an oncological emergency in which early diagnosis and treatment largely determine the patient’s functional prognosis. Its symptoms generally develop gradually over hours, days, or weeks, which varies depending on the biological behavior of the primary tumor. Magnetic resonance imaging is considered the imaging study of choice for the diagnosis of spinal cord compression syndrome. Treatment includes corticosteroids, radiation therapy, surgery, and chemotherapy. A search for original articles, systematic and narrative reviews was performed in the PubMed and Scielo database. From the review of 45 selected articles, a description of the pathophysiology and clinical manifestations of this syndrome was made. Special attention was paid to the different available diagnostic means and the therapeutic options.


REFERENCES

  1. Sciubba DM, Baaj AA, Gokaslan ZL. Spinal Cord Compression.En: Niederhuber JE, Armintage JO, Doroshow JH, etal (Eds). Abeloff's Clinical Oncology. 5th ed. Philadelphia:Churchill Livingstone; 2014: 714-724.

  2. Becker KP, Baehring JM. Spinal Cord Compression. En:DeVita VT, Lawrence TS and Robenberg SA. (Eds). Devita,Hellman, and Rosenberg’s: Cancer: Principles & Practice ofOncology. 10th ed. Philadelphia: Wolters Kluwer Health /Lippincott Williams & Wilkins; 2015; 1816-1821.

  3. Artal C, Calera L, Herrero A. Síndrome de CompresiónMedular. En: Escobar Y, Blasco A, Espinosa J, et al (Eds).Manual SEOM de Cuidados Continuos. 2da ed. Madrid:SEOM; 2014: 296-304.

  4. Cole JS, Patchell. Metastatic epidural spinal cord compression.Lancet Neurol 2008; 7 (5): 459-66. doi:10.1016/S1474-4422(08)70089-9.

  5. Wanman J, Grabowski P, Nystrom H, Gustafsson P, BerghA, Widmark A, et al. Metastatic spinal cord compressionas the first sign of malignancy: outcome after surgery in

  6. 69 patients. Acta Orthopaedica 2017; 88 (4): 457-462. DOI10.1080/17453674.2017.1319179.6. Prasad D, Schiff D. Malignant spinal-cord compression.Lancet Oncol 2005; 6 (1): 15-24.doi:10.1016/S1470-2045(04)01709-7.

  7. Siegal T. Spinal cord compression: from laboratory to clinic.Eur J Cancer 1995; 31A (11): 1748-53.doi:10.1016/0959-

  8. 8049(95)00320-i.8. Arguello F, Baggs RB, Duerst RE, Johnstone L, McQueenK, Frantz TN. Pathogenesis of vertebral metastasis andepidural spinal cord compression. Cancer 1990; 65 (1):

  9. 98-106. doi:10.1002/1097-0142(19900101)65:1<98::aidcncr2820650121>3.0.co;2-k.9. Ropper AE, Ropper AH: Acute spinal cord compression.N Engl J Med 2017; 376 (14): 1358-1369. doi:10.1056/NEJMra1516539.

  10. Helweg-Larsen S, Sorensen PS. Symptoms and signs inmetastatic spinal cord compression: a study from firstsymptom until diagnosis in 153 patients. Eur J Cancer1994; 30A (3): 396-8.doi:10.1016/0959-8049(94)90263-1.

  11. Perrin RG, Laxton AW. Metastatic spine disease: epidemiology,pathophysiology, and evaluation of patients.Neurosurg Clin N Am 2004; 15 (4): 365-73.doi:10.1016/j.nec.2004.04.018.

  12. Boussios S, Cooke D, Hayward C, Kanellos FS, TsiourisAK, Chatziantoniou AA, et al. Metastatic spinal cordcompression: unraveling the diagnostic and therapeuticchallenges. Anticancer Research 2018; 38 (9): 4987-4997.DOI: 10.21873/anticanres.12817.

  13. Lawton AJ, Lee KA, Cheville AL, Ferrone ML, Rades D, BalboniTA, et al. Assessment and management of patientswith metastatic spinal cord compression: a multidisciplinaryreview. J Clin Oncol 2019; 37 (1): 61-71. doi:10.1200/JCO.2018.78.1211.

  14. Maynard FM, Bracken MB, Creasey G, Ditunno JF, DonovanWH, Ducker TB, et al. International Standards for Neurologicaland Functional Classification of Spinal Cord Injury.American Spinal Injury Association. Spinal Cord 1997; 35(5): 266-274.

  15. Savage P, Sharkey R, Kua T, Papanastasopoulos P, McDonald-Burrows Z, Hassan. Clinical characteristics and outcomesfor patients with an initial emergency presentationof malignancy: a 15-month audit of patient level data.Cancer Epidemiology 2015; 39 (1): 86-90. DOI: 10.1016/j.canep.2014.11.001.

  16. Jabehdar Maralani P, Lo SS, Redmond K, Soliman H, MyrehaugS, Husain ZA, et al. Spinal metastases: multimodalityimaging in diagnosis and stereotactic body radiation therapyplanning. Future Oncol 2017; 13 (1): 77-91.doi:10.2217/fon-2016-0238.

  17. Pezaro C, Omlin A, Perez-Lopez R, Mukherji D, Attard G,Bianchini D, et al. Progressive computed tomography (CT)appearance preceding malignant spinal cord compression(MSCC) in men with castration-resistant prostate cancer.Clinical Radiology 2015; 70 (4): 359-365. DOI: 10.1016/j.crad.2014.05.104.

  18. Hussain A, Lee RJ, Graff JN, Halabi S. The evolution andunderstanding of skeletal complication endpoints in clinicaltrials of tumors with metastasis to the bone. Crit ReviewsOncol Hematol 2019; 139: 108-116. DOI: 10.1016/j.critrevonco.2019.04.020.

  19. Zacaron D, Goncalves IC, Ribeiro M. Functional status ofpatients with metastatic spinal cord compression. SupportiveCare Cancer 2018; 26 (9): 3225-3231. doi:10.1007/s00520-018-4182-5.

  20. Nater A, Martin AR, Sahgal A, Choi D, Felhing MG.Symptomatic spinal metastasis: A systematic literaturereview of the preoperative prognostic factors for survival,neurological,functional and quality of life in surgicallytreated patients and methodological recommendations forprognostic studies. PLoS One 2017; 12: e0171507.10.1371/journal.pone.0171507.

  21. Watanabe N, Sugimoto Y, Tanaka M, Mazaki T, Arataki S,Takigawa T, etc al. Neurological recovery after posteriorspinal surgery in patients with metastatic epidural spinalcord compression. Acta Med Okayama 2016; 70 (6): 449-453.doi:10.18926/AMO/54807.

  22. Lei M, Liu S, Yang S, Liu Y, Jiang W, Gao H. Validation ofa model with which to predict the survival prognosisof patients with spinal cord compression resulted frommetastatic cancer. EJSO 2016; 42 (15): 1924-1930. DOI:10.1016/j.ejso.2016.10.003.

  23. George R, Jeba J, Ramkumar G, Chacko AG, Tharyan P.Interventions for the treatment of metastatic extraduralspinal cord compression in adults. Cochrane DatabaseSyst Rev 2015 (9): CD006716. doi:10.1002/14651858.CD006716.pub3.

  24. Kumar A, Weber MH, Gokaslan Z, et al. Metastatic spinalcord compression and steroid treatment: A systematicreview. Clin Spine Surg 2017; 30: 156-163.

  25. Skeoch GD, Tobin MK, Khan S, Linninger AA, Mehta AI.Coerticoesteroid therapy for metastatic spinal cord compression:A review. Global Spine J 2017; 7 (3): 272-279.DOI: 10.1177/2192568217699189.

  26. Delattre JY, Arbit E, Thaler HT, Posner JB. A dose-responsestudy of dexamethasone in a model of spinal cord compressioncaused by epidural tumor. J Neurosurg 1989; 70(6): 920-5.doi:10.3171/jns.1989.70.6.0920.

  27. Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, FehlingsMG, Ondra SL, et al. Diagnosis and management of metastaticspine disease: a review. J Neurosurg Spine 2010; 13(1): 94-108. doi:10.3171/2010.3.SPINE09202.

  28. Weissman DE, Dufer D, Vogel V, Abeloff MD. Corticosteroidtoxicity in neuro-oncology patients. J Neurooncol 1987; 5(2): 125-128. doi:10.1007/bf02571300.

  29. Heimdal K, Hirschberg H, Slettebø H, Watne K, Nome O.High incidence of serious side effects of high-dose dexamethasonetreatment in patients with epidural spinalcord compression. J Neurooncol 1992;12(2):141–144.doi:10.1007/bf00172664.

  30. Loblaw A, Mitera G, Ford M, Laperriere A .2011 updatesystematic review and clinical practice guidelines for themanagement of malignant extradural spinal cord compression.Int J Radiat Oncol Biol Phys 2012;84(2):312–317.doi:10.1016/j.ijrobp.2012.01.014.

  31. Koksoy EB, Urun Y. Spinal Cord Compression. En: ProvencioM (Ed). ESMO Handboook of Oncological Emergencies. 2nded. Lugano: ESMO Press; 2016: 71-75.

  32. Maranzano E, Bellavita R, Rossi R, De Angelis V, FrattegianiA, et al. Short-course versus Split course radiotherapy inmetastatic spinal cord compression: Results of a phase III,randomized, multicenter trial. J Clin Oncol 2005; 23 (15):

  33. 3358-3365. doi:10.1200/JCO.2005.08.193.33. Maranzano E, Trippa F, Casale M, Constantini S, LupattelliM, et al. 8 Gy single-dose radiotherapy is effective inmetastatic spinal cord compression: Results of a phaseIII randomized multicentre Italian trial. Radiother Oncol2009; 93 (2): 174-179. doi:10.1016/j.radonc.2009.05.012.

  34. Rades D, Stalpers LJ, Veninga T, Schulte R , Hoskin PJ, etal. Evaluation of five radiation schedules and prognosticfactors for metastatic spinal cord compression. J Clin Oncol2005; 23 (15): 3366-3375. doi:10.1200/JCO.2005.04.754.

  35. Hoskin PJ, Hopkins K, Misra V, Holt T, McMenemin R,Dubois D, et al. Effect of single-fraction vs multifractionradiotherapy on ambulatory status among patients withspinal canal compression from metastatic cancer: TheSCORAD randomized clinical trial. JAMA 2019; 322 (21):2084-2094. DOI: 10.1001/jama.2019.17913.

  36. Giraldo A, Benavente S, Ramos M, Verges R, Coronil O,Arbeláez L, et al. Effectiveness of radiotherapy for metastaticspinal cord compression in patients with short lifeexpectancy. Rep Pract Oncol Radiother 2017; 22 (1): 58-63.DOI: 10.1016/j.rpor.2016.09.007.

  37. Suppli MH. Approaches to radiotherapy in metastatic spinalcord compression. Dan Med J 2018; 65 (4): B5451.

  38. Janssen S, Bolm L, Käsmann L, Bartscht T, Rades D, Palliativeradiation therapy for spinal cord compression from metastaticsoft tissue sarcoma. In Vivo 2016; 30 (4): 529-532.

  39. Greenberg HS, Kim JH, Posner JB. Epidural spinal cordcompression from metastatic tumor: results with a newtreatment protocol. Ann Neurol 1980; 8 (4): 361-366.doi:10.1002/ana.410080404.

  40. Lo WY, Yang SH. Metastatic spinal cord compression (MSCC)treated with palliative decompression: surgical timing andsurvival rate. PLoS ONE 2017; 12 (12): e0190342. DOI:10.1371/journal.pone.0190342.

  41. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, et al.Direct decompressive surgical resection in the treatmentof spinal cord compression caused by metastatic cancer:a randomised trial. Lancet 2005; 366 (9486): 643-648.doi:10.1016/S0140-6736(05)66954-1.

  42. Nater A, Fehlings MG. Survival and clinical outcomes inpatients with metastatic epidural spinal cord compressionafter spinal surgery: a prospective, multicenter, observationalcohort study. Chin J Cancer 2016; 35: 27. DOI: 10.1186/s40880-016-0091-5.

  43. Boogerd W, van der Sande JJ, Kroger R, Bruning PF, SomersR. Effective systemic therapy for spinal epidural metastasesfrom breast carcinoma. Eur J Cancer Clin Oncol 1989; 25(1): 148-53. DOI:10.1016/0277-5379(89)90066-7.

  44. Al-Qurainy R, Collis E. Metastatic spinal cord compression:diagnosis and management. BMJ 2016; 353: i2539. DOI:10.1136/bmj.i2539.

  45. Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, et al. Palliativeradiation therapy for bone metastases: update of an ASTROevidence-based guidelines. Pract Radiat Oncol 2017; 7 (1):4-12. doi:10.1016/j.prro.2016.08.001.




2020     |     www.medigraphic.com