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Alhalabi OT, Heene S, Landré V, Neumann JO, Scherer M, Ishak B, Kiening K, Zweckberger K, Unterberg AW, Younsi A. Spinal oncologic paraparesis: Analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors. Front Oncol 2023; 12:1003084. [PMID: 36686806 PMCID: PMC9846080 DOI: 10.3389/fonc.2022.1003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Objectives Paraparesis due to oncologic lesions of the spine warrants swift neurosurgical intervention to prevent permanent disability and hence maintain independence of affected patients. Clinical parameters that predict a favorable outcome after surgical intervention could aid decision-making in emergency situations. Methods Patients who underwent surgical intervention for paraparesis (grade of muscle strength <5 according to the British Medical Research Council grading system) secondary to spinal neoplasms between 2006 and 2020 were included in a single-center retrospective analysis. Pre- and postoperative clinical data were collected. The neurological status was assessed using the modified McCormick Disability Scale (mMcC) Score. In a univariate analysis, patients with favorable (discharge mMcC improved or stable at <3) and non-favorable outcome (discharge mMcC deteriorated or stable at >2) and different tumor anatomical compartments were statistically compared. Results 117 patients with oncologic paraparesis pertaining to intramedullary lesions (n=17, 15%), intradural extramedullary (n=24, 21%) and extradural lesions (n=76, 65%) with a mean age of 65.3 ± 14.6 years were included in the analysis. Thoracic tumors were the most common (77%), followed by lumbar and cervical tumors (13% and 12%, respectively). Surgery was performed within a mean of 36±60 hours of admission across all tumors and included decompression over a median of 2 segments (IQR:1-3) and mostly subtotal tumor resection (n=83, 71%). Surgical and medical complications were documented in 9% (n=11) and 7% (n=8) of cases, respectively. The median hospital length-of-stay was 9 (7-13) days. Upon discharge, the median mMcC score had improved from 3 to 2 (p<0.0001). At last follow-up (median 180; IQR 51-1080 days), patients showed an improvement in their mean Karnofsky Performance Score (KPS) from 51.7±18.8% to 65.3±20.4% (p<0.001). Localization in the intramedullary compartment, a high preoperative mMcC score, in addition to bladder and bowel dysfunction were associated with a non-favorable outcome (p<0.001). Conclusion The data presented on patients with spinal oncologic paraparesis provide a risk-benefit narrative that favors surgical intervention across all etiologies. At the same time, they outline clinical factors that confer a less-favorable outcome like intramedullary tumor localization, a high McCormick score and/or bladder and bowel abnormalities at admission.
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Affiliation(s)
- Obada T. Alhalabi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany,*Correspondence: Obada T. Alhalabi,
| | - Stefan Heene
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Vincent Landré
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan-Oliver Neumann
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Zweckberger
- Department of Neurosurgery, City Hospital of Brunswick, Brunswick, Germany
| | | | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Kim KN, LaRiviere M, Macduffie E, White CA, Jordan-Luft MM, Anderson E, Ziegler M, Radcliff JA, Jones J. Use of Glucocorticoids in Patients With Cancer: Potential Benefits, Harms, and Practical Considerations for Clinical Practice. Pract Radiat Oncol 2023; 13:28-40. [PMID: 35917896 DOI: 10.1016/j.prro.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Glucocorticoids are commonly used in patients with cancer for symptom relief or as part of their anticancer treatment. Despite their frequent use, indications and dosing regimens are not exclusively evidence-based and can come with a multitude of adverse effects, some of which can be life-threatening. The objective of this review is to update our current state of knowledge on the use of glucocorticoids in adult patients with cancer. METHODS AND MATERIALS A comprehensive literature review (1949-2022) was conducted using search terms "glucocorticoids," "corticosteroids," and "cancer." Information was organized by main concepts including indications, potential benefits, and prevention and management of common side effects of glucocorticoid therapy, in addition to appropriate dosing and taper regimens. RESULTS Glucocorticoids can be highly effective in improving outcomes and quality of life in patients with cancer. Their uses include management of disease manifestations, symptoms, and complications of cancer treatment. The lowest effective dose should be used and treatment duration should be minimized as clinically feasible. Side effects can be minimized by careful monitoring, continued assessment of benefits versus harms, and preventative measures for expected side effects. CONCLUSIONS This review provides general principles and practical recommendations on the use of glucocorticoids in patients with cancer. Further prospective studies on the outcomes of patients on glucocorticoids may help guide practice.
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Affiliation(s)
- Kristine N Kim
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Michael LaRiviere
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Emily Macduffie
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Caitlin A White
- Department of Medicine, Division of Endocrinology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mary M Jordan-Luft
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Eleanor Anderson
- Department of Psychiatry, Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Matthew Ziegler
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacob A Radcliff
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua Jones
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Ghedira H, Radhouane K, Mezni E, Yahiaoui S, Stambouli H, Yedeas MD, Belaid A, Ammar C, Kacem K, Zriba S, Msadek F, Yedeas M, Harbaoui A, Chkili R. Impact of local treatment on survival from hematological malignancies causing spinal cord compression. Surg Neurol Int 2020; 11:352. [PMID: 33194285 PMCID: PMC7656002 DOI: 10.25259/sni_592_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Various hematological malignancies, including multiple myeloma, plasmacytoma, aggressive lymphoma, and indolent lymphoma, rarely result in spinal cord compression. Methods: Here, we retrospectively analyzed 32 patients with multiple myeloma (50%), plasmacytoma (13%), aggressive lymphoma (28%), and indolent lymphoma (9%), resulting in spinal cord compression (2004 and 2016). Patients averaged 57 years of age and presented with the indolent onset of spinal cord compression (91% of cases) resulting mostly in motor deficits (69%). Results: Local treatment modalities included radiotherapy (RT) (28%) alone, decompressive surgery (28%) alone, or decompressive surgery with consolidation RT (40%). The 1-year overall survival was 70%, and the progression-free survival frequency was 62%. Conclusion: This study highlighted the importance of standardizing the indications for RT alone versus RT with surgery depending on the patient’s underlying pathological diagnosis, neurological deficits, and radiological findings.
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Affiliation(s)
- Hela Ghedira
- Department of Hematology Bab Saadoun, Tunis, Tunisia
| | - Khaled Radhouane
- Department of Neurosurgery, Military Hospital of Tunis, Bab Saadoun, Tunis, Tunisia
| | - Essia Mezni
- Department of Hematology Bab Saadoun, Tunis, Tunisia
| | - Safia Yahiaoui
- Department of Radiotherapy, Salah Azaiez Institue, Bab Saadoun, Tunis, Tunisia
| | | | | | - Asma Belaid
- Department of Radiotherapy, Salah Azaiez Institue, Bab Saadoun, Tunis, Tunisia
| | - Chiraz Ammar
- Department of Radiotherapy, Salah Azaiez Institue, Bab Saadoun, Tunis, Tunisia
| | - Karima Kacem
- Department of Hematology, Aziza Othmana University Hospital, Faculty of Medecine of Tunis, University Tunis El Manar, Bab Saadoun, Tunis, Tunisia
| | - Samy Zriba
- Department of Hematology Bab Saadoun, Tunis, Tunisia
| | - Fehmi Msadek
- Department of Hematology Bab Saadoun, Tunis, Tunisia
| | - Mondher Yedeas
- Department of Neurosurgery, Military Hospital of Tunis, Bab Saadoun, Tunis, Tunisia
| | - Ahmed Harbaoui
- Department of Neurosurgery, Military Hospital of Tunis, Bab Saadoun, Tunis, Tunisia
| | - Ridha Chkili
- Department of Neurosurgery, Military Hospital of Tunis, Bab Saadoun, Tunis, Tunisia
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Primary Extramedullary, Extradural Cervical Spine Seminoma. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e1900177. [PMID: 32672721 PMCID: PMC7366419 DOI: 10.5435/jaaosglobal-d-19-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While extragonadal seminomas resulting in spinal cord compression are rarely reported in the literature, most have been treated with surgical decompression followed by radiation therapy. In this report, we present the unique and interesting case of a 38-year-old man who initially presented as an outpatient with a chief complaint of axial neck pain and lateral thoracic wall pain. After an extensive malignancy workup, he was diagnosed with a primary cervical spine seminoma and was treated with a C6-T1 laminectomy with posterior spinal instrumentation from C5 to T2. He has since undergone chemotherapy with cisplatin, vinblastine, and bleomycin, and at 24-month follow-up, he remains asymptomatic with no signs of recurrent disease.
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Dakson A, Leck E, Brandman DM, Christie SD. The clinical utility of the Spinal Instability Neoplastic Score (SINS) system in spinal epidural metastases: a retrospective study. Spinal Cord 2020; 58:892-899. [PMID: 32047252 DOI: 10.1038/s41393-020-0432-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES This study assessed the clinical utility of the Spinal Instability Neoplastic Score (SINS) in relation to the surgical treatment of spinal epidural metastasis and factors important for surgical decision-making. These factors include epidural spinal cord compression (ESCC), patient prognosis and neurologic status. SETTING Queen Elizabeth II Health Sciences Centre, Halifax, Canada. METHODS We identified 285 patients with spinal metastatic disease. Data were extracted through a retrospective review. SINS and ESCC were scored based on CT and MRI, respectively. RESULTS Patients were grouped into stable (35%), potentially unstable (52%), and unstable (13%) groups. The overall incidence of metastatic spinal deformity was 9%. Surgical interventions were performed in 21% of patients, including decompression and instrumented fusion (70%), decompression alone (17%), percutaneous vertebral augmentation (9%), and instrumented vertebral augmentation (5%). The use of spinal instrumentation was significantly associated with unstable SINS (p = 0.005). Grade 3 ESCC was also significantly associated with unstable SINS (p < 0.001). Kaplan-Meier analysis revealed that SINS was not a predictor of survival (p = 0.98). In the radiotherapy-alone group, a significant proportion of patients with potentially unstable SINS (30%) progressed into unstable SINS category at an average 364 ± 244 days (p < 0.001). CONCLUSION This study demonstrated that more severe categories of SINS were associated with higher degrees of ESCC, and surgical interventions were more often utilized in this group with more frequent placement of spinal instrumentation. Although SINS did not predict patient prognosis, it correlates with the progression of metastatic instability in patients treated with radiotherapy.
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Affiliation(s)
- Ayoub Dakson
- Division of Neurosurgery, Halifax Infirmary, 1796 Summer Street, Room 3814, Halifax, Nova Scotia, B3H 3A7, Canada
| | - Erika Leck
- Division of Neurosurgery, Halifax Infirmary, 1796 Summer Street, Room 3814, Halifax, Nova Scotia, B3H 3A7, Canada
| | - David M Brandman
- Division of Neurosurgery, Halifax Infirmary, 1796 Summer Street, Room 3814, Halifax, Nova Scotia, B3H 3A7, Canada
| | - Sean D Christie
- Division of Neurosurgery, Halifax Infirmary, 1796 Summer Street, Room 3814, Halifax, Nova Scotia, B3H 3A7, Canada.
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Park SB, Kim KJ, Han S, Oh S, Kim CH, Chung CK. Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine. J Korean Neurosurg Soc 2018; 61:415-423. [PMID: 29631384 PMCID: PMC5957313 DOI: 10.3340/jkns.2017.0505.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/13/2017] [Accepted: 09/06/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. METHODS We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. RESULTS There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). CONCLUSION When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.
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Affiliation(s)
- Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ki Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sanghyun Han
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
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Galgano M, Fridley J, Oyelese A, Telfian A, Kosztowski T, Choi D, Gokaslan ZL. Surgical management of spinal metastases. Expert Rev Anticancer Ther 2018; 18:463-472. [PMID: 29560739 DOI: 10.1080/14737140.2018.1453359] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Metastatic spinal disease is a source of significant morbidity in patients with cancer. Recent advancements in adjuvant oncologic therapy has led to increased survival for many patients who harbor neoplastic disease. As a result of this, the chance of developing metastatic spinal disease over the course of a cancer patient's lifespan has increased. Symptomatic metastatic spinal disease can cause significant morbidity including severe pain, neurologic deficit, and loss of ambulation. Current treatment of these patients typically involves the use of multiple modalities, including surgery, radiation, and chemotherapy. Areas covered: An extensive literature review was performed to support the author's opinion on the matter of surgical management of spinal metastatic disease. Pubmed was utilized as a primary search engine. Expert commentary: Despite advances in chemotherapy and radiation therapy, surgery remains a mainstay in many of these patients, particularly with those with either significant metastatic spinal epidural compression or spinal instability. This review discusses the surgical management of metastatic spinal disease including a framework for decision making and technical considerations when deciding to operate on these patients.
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Affiliation(s)
- Michael Galgano
- a Department of Neurosurgery , Warren Alpert Medical School of Brown University , Providence , USA
| | - Jared Fridley
- a Department of Neurosurgery , Warren Alpert Medical School of Brown University , Providence , USA
| | - Adetokunbo Oyelese
- a Department of Neurosurgery , Warren Alpert Medical School of Brown University , Providence , USA
| | - Albert Telfian
- a Department of Neurosurgery , Warren Alpert Medical School of Brown University , Providence , USA
| | - Thomas Kosztowski
- a Department of Neurosurgery , Warren Alpert Medical School of Brown University , Providence , USA
| | - David Choi
- a Department of Neurosurgery , Warren Alpert Medical School of Brown University , Providence , USA
| | - Ziya L Gokaslan
- a Department of Neurosurgery , Warren Alpert Medical School of Brown University , Providence , USA
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Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery! Spine J 2017; 17:759-767. [PMID: 26239762 DOI: 10.1016/j.spinee.2015.07.440] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/31/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. PURPOSE We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. STUDY DESIGN We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. PATIENT SAMPLE There were 1,266 patients recruited between March 2001 and October 2014. OUTCOME MEASURES Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. METHODS We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: <70, 70-80, and >80 years. RESULTS Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients <70 years, p=.004). EQ-5D improved in all groups, but survival expectancy was significantly longer in patients <70 years old (p=.02). Furthermore, neurologic recovery after surgery was lower in patients >80 years old. CONCLUSIONS Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.
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Skeoch GD, Tobin MK, Khan S, Linninger AA, Mehta AI. Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review. Global Spine J 2017; 7:272-279. [PMID: 28660111 PMCID: PMC5476356 DOI: 10.1177/2192568217699189] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Metastatic spinal cord compression (MSCC) is a very frequent complication among cancer patients. Presenting commonly as nocturnal back pain, MSCC typically progresses to lower extremity paresis, loss of ambulatory capabilities, and paraplegia. In addition to standard treatment modalities, corticosteroid administration has been utilized in preclinical and clinical settings as adjunctive therapy to reduce local spinal cord edema and improve clinical symptoms. This article serves as a review of existing literature regarding corticosteroid management of MSCC and seeks to provide potential avenues of research on the topic. METHODS A literature search was performed using PubMed in order to consolidate existing information regarding dexamethasone treatment of MSCC. Of all search results, 7 articles are reviewed, establishing the current understanding of metastatic spine disease and dexamethasone treatment in both animal models and in clinical trials. RESULTS Treatment with high-dose corticosteroids is associated with an increased rate of potentially serious systemic side effects. For this reason, definitive guidelines for the use of dexamethasone in the management of MSCC are unavailable. CONCLUSIONS It is still unclear what role dexamethasone plays in the treatment of MSCC. It is evident that new, more localizable therapies may provide more acceptable treatment strategies using corticosteroids. Looking forward, the potential for more targeted, localized application of the steroid through the use of nanotechnology would decrease the incidence of adverse effects while maintaining the drug's efficacy.
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Affiliation(s)
| | | | | | | | - Ankit I. Mehta
- University of Illinois at Chicago, IL, USA,Ankit I. Mehta, Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street M/C, 799, Chicago, IL 60612, USA.
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Rasool MT, Fatima K, Manzoor NA, Mustafa SA, Maqbool LM, Qamar WS, Afroz F, Khan NA, Shah SA, Shah M. Profile of Malignant Spinal Cord Compression: One Year Study at Regional Cancer Center. Indian J Palliat Care 2016; 22:125-9. [PMID: 27162421 PMCID: PMC4843549 DOI: 10.4103/0973-1075.179605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: Malignant spinal cord compression is an oncologic emergency, unless diagnosed early and treated appropriately, can lead to permanent neurological impairment and compromised quality of life of patients. We analyzed the epidemiology and the effect of common interventions on the outcome in these patients. Patients and Methods: We conducted a prospective study of 77 patients in the year 2014 and recorded relevant patient and disease characteristics. All patients received corticosteroids. Eight patients were operated upon, and radiotherapy was delivered in 62 patients. Results: Most of the patients were in the age group of 41–60 years and there was no gender preponderance in patients. Female breast cancer was the most common incident (15.5%) malignancy followed by multiple myeloma, lung, and prostatic carcinoma. Lower dorsal spine was the most common site of compression (35%) followed by lumbar (31%) and mid-dorsal (26%) spine. 70 (91%) patients had cord compression subsequent to bone metastasis while as other patients had leptomeningeal metastasis. In 31 (40%) patients, spinal cord compression was the presenting symptom. Overall, only 26 patients had motor improvement after treatment. Conclusion: Grade of power before treatment was predictive of response to treatment and overall outcome of motor or sensory functions. Neurodeficit of more than 10 days duration was associated with poor outcome in neurological function.
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Affiliation(s)
- Malik Tariq Rasool
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Kaneez Fatima
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Najmi Arshad Manzoor
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Syed Arshad Mustafa
- Department of Radiation Oncology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Lone Mohammad Maqbool
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Wani Shaqul Qamar
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Fir Afroz
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nazir Ahmad Khan
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Saqib Ahmad Shah
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Manan Shah
- Department of Radiation Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Eap C, Tardieux E, Goasgen O, Bennis S, Mireau E, Delalande B, Cvitkovik F, Baussart B, Aldea S, Jovenin N, Gaillard S. Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases. Orthop Traumatol Surg Res 2015; 101:483-8. [PMID: 25910701 DOI: 10.1016/j.otsr.2015.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 02/08/2015] [Accepted: 03/11/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Metastatic disease of the spine is an increasingly common public health problem. Surgery should be an integral component of the overall cancer treatment plan and, importantly, must neither delay not jeopardize any of the other components. The prognosis governs the choice of the surgical strategy. Tokuhashi et al. developed a prognostic score in 1990, then revised it in 2000 and 2005. Here, our objective was to evaluate the performance of the Tokuhashi score in a cohort of 260 patients and to look for other variables that might improve preoperative outcome prediction. MATERIAL AND METHOD We retrospectively established a single-centre cohort of 260 patients who underwent spinal metastasis surgery between 1998 and 2008. For each patient, the following data were collected prospectively: socio-demographic features, history of the malignancy, variables needed to determine the Tokuhashi score, and treatments used. SAS 9.0 software was chosen for the statistical analysis. Variables were described as mean ± SD, overall survival was estimated using the Kaplan-Meier method, and survivals in subgroups were compared by the log-rank test. To assess agreement between survival predicted by the Tokuhashi score and observed survival, we computed Cohen's kappa and interpreted the results according to Landis and Koch. RESULTS There were 143 females and 117 males with a mean age of 59 years and overall median survival of 10 months. Median observed survivals in the three Tokuhashi score categories (< 6, 6-12, and > 12 months predicted survival) were 5, 10, and 36 months, respectively. These survival times differed significantly (P < 0.0001). Cohen's kappa indicated moderate agreement between predicted and observed survivals. Other factors associated with significant survival differences were time from cancer diagnosis to metastasis diagnosis (synchronous, < 2 years, 2-5 years, or > 5 years; P < 0.0001) and age (< 70 years or ≥ 70 years, P = 0.0053). CONCLUSION Our cohort study supports the validity and reproducibility of the Tokuhashi score. Our finding that shorter time to metastasis diagnosis and age ≥ 70 years were also significantly associated with survival in our population invites further efforts to improve and update the Tokuhashi score.
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Affiliation(s)
- C Eap
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France.
| | - E Tardieux
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - O Goasgen
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Bennis
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - E Mireau
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - B Delalande
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - F Cvitkovik
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - B Baussart
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Aldea
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - N Jovenin
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Gaillard
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
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12
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Abstract
Back pain is a common presenting complaint to the emergency department. The key to proper evaluation is a history and physical examination focused on determining if any red flags for serious disease are present. If no red flags are present, the patient most likely has nonspecific back pain and their symptoms will resolve in 4 to 6 weeks. No diagnostic testing is required. For patients with red flags, a focused history and examination in conjunction with diagnostic laboratory tests and imaging determine whether the patient has an emergent condition such as herniated disc, epidural compression, or spinal infection.
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Affiliation(s)
- David Della-Giustina
- Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519-1315, USA.
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13
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Bouhafa T, Elmazghi A, Masbah O, Hassouni K. [Spinal cord compression due to metastases]. Pan Afr Med J 2014; 19:209. [PMID: 25829974 PMCID: PMC4372306 DOI: 10.11604/pamj.2014.19.209.3695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/23/2014] [Indexed: 11/11/2022] Open
Abstract
La compression médullaire d'origine métastatique est une complication neurologique fréquente du cancer. C'est une urgence diagnostique et thérapeutique qui nécessite une prise en charge rapide et efficace. L'imagerie par résonnance magnétique (IRM) constitue l'examen de choix pour l'exploration de l'ensemble de la moelle. La prise en charge thérapeutique doit être multidisciplinaire incluant la corticothérapie, la radiothérapie et la chirurgie.
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Affiliation(s)
- Touria Bouhafa
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Abderrahman Elmazghi
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Ouafae Masbah
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Khalid Hassouni
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
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14
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L'espérance S, Vincent F, Gaudreault M, Ouellet JA, Li M, Tosikyan A, Goulet S. Treatment of metastatic spinal cord compression: cepo review and clinical recommendations. ACTA ACUST UNITED AC 2013; 19:e478-90. [PMID: 23300371 DOI: 10.3747/co.19.1128] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Metastatic spinal cord compression (mscc) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l'évolution des pratiques en oncologie (cepo) made recommendations on mscc management. METHOD A review of the scientific literature published up to February 2011 considered only phase ii and iii trials that included assessment of neurologic function. A total of 26 studies were identified. RECOMMENDATIONS Considering the evidence available to date, cepo recommends that cancer patients with mscc be treated by a specialized multidisciplinary team.dexamethasone 16 mg daily be administered to symptomatic patients as soon as mscc is diagnosed or suspected.high-loading-dose corticosteroids be avoided.histopathologic diagnosis and scores from scales evaluating prognosis and spinal instability be considered before treatment.corticosteroids and chemotherapy with radiotherapy be offered to patients with spinal cord compression caused by myeloma, lymphoma, or germ cell tumour without sign of spinal instability or compression by bone fragment.short-course radiotherapy be administered to patients with spinal cord compression and short life expectancy.long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy.decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic mscc patients (including spinal instability, displacement of vertebral fragment); andpatients considered for surgery have a life expectancy of at least 3-6 months.
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Affiliation(s)
- S L'espérance
- Comité de l'évolution des pratiques en oncologie, Quebec City, QC
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15
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Kim CH, Chung CK, Jahng TA, Kim HJ. Surgical outcome of spinal hepatocellular carcinoma metastases. Neurosurgery 2012; 68:888-96. [PMID: 21221023 DOI: 10.1227/neu.0b013e3182098c18] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Spinal hepatocellular carcinoma (HCC) metastases are increasing with improved survival of patients with HCC. However, its treatment outcome, particularly regarding functional outcome, has not been adequately investigated. OBJECTIVE To present the surgical outcome of spinal HCC metastases and demonstrate prognostic factors for survival and ambulation time. METHODS Thirty-three patients (30 males, 3 females) were retrospectively reviewed. Child-Pugh classification was used to assess hepatic function. Preoperatively, 19 patients could ambulate (group A) and 14 patients could not (group B). Preoperatively, 18 patients received conventional fractionated radiotherapy. RESULTS The spinal metastases were removed to achieve sufficient neural decompression. If destabilization developed, instrumentation and/or vertebroplasty were performed. Postoperatively, conventional radiotherapy was administered to 13 patients. Patients survived for 203 ± 31 days. Child-Pugh classification and preoperative/postoperative ambulatory ability were correlated with survival time, with Child-Pugh classification being the most significant factor (hazard ratio, 3.75; 95% confidence interval: 1.38-10.22). After the operation, ambulatory ability was maintained in all group A patients and was recovered in 4 in group B. Twenty-three patients could ambulate for 285 ± 62 days. Preoperative ambulatory status and Child-Pugh classification were correlated with a longer ambulatory period, with preoperative ambulatory status most significant (hazard ratio, 8.62; 95% confidence interval: 2.39-31.04). Patients died 81 ± 71 days after the loss of ambulatory ability, regardless of postoperative ambulatory status. CONCLUSION In spinal HCC metastasis, ambulatory status and hepatic function were significantly correlated with survival and ambulation time. Both ambulatory status and hepatic function should be considered in the selection of surgical candidates.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
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16
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Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin 2011; 61:287-314. [PMID: 21858793 DOI: 10.3322/caac.20124] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Oncologic emergencies can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient's cancer history and its possible complications forms an important part of any clinician's knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This article reviews hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, cardiac tamponade, superior vena cava syndrome, neutropenic fever, spinal cord compression, increased intracranial pressure, seizures, hyperviscosity syndrome, leukostasis, and airway obstruction in patients with malignancies. Chemotherapeutic emergencies are also addressed.
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Affiliation(s)
- Mark A Lewis
- Senior Hematology and Oncology Fellow, Division of Hematology, Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN
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17
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Yee D, Gabos Z, North S, Moore RB. Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance. Can Urol Assoc J 2011; 1:59-63. [PMID: 18542765 DOI: 10.5489/cuaj.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We report cases of 2 pure seminoma patients who developed metastatic spinal cord compressions. One patient was diagnosed at age 33 years with stage 1 seminoma and, after undergoing an orchidectomy, chose to be followed on a surveillance protocol. He was lost to follow-up and presented again 22 months later with back pain, leg weakness and sensory loss when his disease recurred as a spinal cord compression. He was treated with urgent surgical decompression and subsequent standard chemotherapy. More than 2 years posttreatment, he is disease-free with normal neurologic function in his lower extremities. The second patient presented at age 44 years with back pain and rapid loss of leg strength and sensation. Investigations revealed a malignant cord compression with lymphatic and vertebral body metastases. On physical examination, the patient was found to have a 6-cm left testicular mass. He was treated with emergency radiotherapy to the region of his cord compression followed by a left inguinal orchidectomy. Pathology confirmed a pure classic seminoma. Postoperatively, he received standard chemotherapy and eventually regained neurologic function in his legs. Although it is rare for malignant spinal cord compression to occur in seminoma patients-either as the initial presentation of disease or as a site of disease recurrence in stage 1 patients on surveillance-it is crucial to consider seminoma as a possible etiology in young men diagnosed with malignant spinal cord compression because timely contemporary treatments for seminoma will cure most of these patients and offer them excellent functional recovery.
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Affiliation(s)
- Don Yee
- Department of Oncology, and Division of Radiology, Cross Cancer Institute, Edmonton, Alta
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18
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Abstract
Oncologic emergencies represent a wide variety of conditions that can occur at any time during the course of a malignancy, from an initial presenting manifestation in someone with an undiagnosed cancer, to end-stage incurable metastatic disease. Emergent conditions can also arise after a malignancy has been in remission for many years, even decades, so clinicians must be aware of any prior history of cancer in patients. Oncologic emergencies include conditions caused by the cancer itself or side effects of therapy. Emergent conditions include metabolic, cardiac, neurologic, or infectious disorders. Many of these emergencies are imminently life-threatening, and can occur in patients with curable disease (such as lymphomas or leukemias); however, many also present in patients with incurable advanced disease. Prompt recognition and treatment of these conditions can lead to markedly improved quality and quantity of life.
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Affiliation(s)
- Deepti Behl
- Hematology and Oncology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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