Surgical and Radiotherapeutic Management of Malignant Extradural Spinal Cord Compression |
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| Affiliation: | 1. Sunnybrook Health Sciences Centre, Toronto, Canada;2. Salford Royal Foundation Trust, Manchester, UK;3. The Christie Hospital, Manchester, UK;1. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada;2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA;3. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada;4. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK;1. Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, USA;2. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA;3. Department of Radiation Oncology, West Virginia University School of Medicine, Morgantown, USA;4. Department of Radiation Oncology and Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, USA;5. Department of Radiation Oncology, Sunnybrook Hospital, Toronto, Canada;6. Departments of Neurosurgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA;7. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA;8. Department of Radiation Oncology, Mayo Clinic, Jacksonville, USA;1. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;2. Department of Radiotherapy, Dr Bernard Verbeeten Institute, Tilburg, The Netherlands;3. Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizkaya, Spain;4. Department of Radiation Oncology, University and Polytechnic Hospital La Fe, Valencia, Spain;5. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ;1. London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, Canada;2. Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada;3. Mount Vernon Hospital, London, United Kingdom;4. University of Manchester, United Kingdom;5. Mayo Clinic, Scottsdale, USA;6. British Columbia Cancer Agency Vancouver Centre, Canada;1. Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK;2. Department of Orthopaedics, University Hospitals of Leicester, Leicester, UK;3. Department of Clinical Oncology, Royal Marsden Hospital, London, UK;4. Department of Orthopaedics, Manchester University Hospitals, Manchester, UK;5. Department of Radiation Oncology, BC Cancer Centre for the North, British Columbia, Canada;7. Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India |
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| Abstract: | Malignant spinal cord compression is one of the most dreaded complications of advanced malignancy, with patients presenting with progressive paralysis, paresthesia and/or autonomic dysfunction. The choice of management should be guided by the expected prognosis and outcome, not just from a neurological function point-of-view but also from the metastatic cancer itself. The main indications for surgery are: impending cord compression, spinal instability from tumour progression, bony retropulsion, for tissue diagnosis and for pain resistant to conventional therapies. Here, surgical principles, traditional and novel techniques and complications will be reviewed. For radiotherapy, multiple randomised studies have shown that for most patients a single fraction of external radiation has the same functional outcomes compared with multi-fractionation protocols. The experience of a specialised centralised interdisciplinary team will also be discussed. |
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| Keywords: | Quality of life radiation spinal cord compression surgery toxicity |
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