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Treatment of spinal epidural metastasis improves patient survival and functional state

From the Neurology Service and Rehabilitation and Spinal Cord Injury and Dysfunction Care Line, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, and Department of Neurology, Case Western Reserve University, Cleveland, OH.

Address correspondence and reprint requests to Drs. Osama O. Zaidat and Robert L. Ruff, Neurology Service 127(W), Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106.

Objectives: To determine factors affecting the success of radiation therapy (RT) of spinal epidural metastases and patient survival after RT.

Design/Methods: One hundred thirty-nine male veterans with an initial spinal epidural metastases treated with dexamethasone and RT were evaluated prospectively. Patients were followed until death.

Results: At presentation, 84 patients could walk. After RT, 119 patients walked. The likelihood of regaining ambulation increased if treatment began <12 hours after loss of ambulation and if patients had bladder and bowel function and sacral sensory sparing. Treatment reduced pain levels, and ambulatory patients had less pain compared with nonambulatory patients. Median length of survival was 104 weeks for ambulatory patients and 6 weeks for nonambulatory patients. Mean interval between loss of ambulation and death was 4.0 ± 0.5 weeks. Recurrent spinal epidural metastases occurred in 8.63% of patients.

Conclusions: Patients who walked after treatment lived longer, were ambulatory for most of their remaining life, had less pain, and had a lower incidence of depression.

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				P. Klimo Jr. and M. H. Schmidt Surgical Management of Spinal Metastases Oncologist, April 1, 2004; 9(2): 188 - 196. [Abstract] [Full Text] [PDF]