Abstract
The object of this study was to statistically analyze the survival patterns in patients with metastatic cauda equina compression and to determine the factors that may be predictive of prognosis. Between 1980 and 1999, 76 patients were diagnosed and treated for metastatic tumors causing cauda equina compression. Pain was the presenting feature in 67% of patients. The most common site for the primary tumor was the lung (21%). All patients received external beam radiation with a dose range of 4 Gy to 38 Gy (mean = 25 Gy). Median length of patient survival was 4.0 ± 0.9 months (range: 1–152 months). The 12-month actuarial survival calculated using the Kaplan-Meier method was 17.52 ± 4.5% (95% confidence interval). Factor analysis of overall survival revealed that an increase in radiation dose (>20 Gy) correlated with longer survival (P < 0.001). Patients with lymphoma had the best prognosis, whereas those with lung and prostate primary cancer faired worst. Primary cancer is the most useful predictor of prognosis in patients with metastatic cauda equina compression. Although radiation remains the treatment of choice, the addition of surgery offers significant improvement in the symptoms and hence increases quality of life for long-term survivors.
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