Hormonal therapy with external radiation therapy for metastatic spinal cord compression from newly diagnosed prostate cancer

Abstract

BackgroundAlthough hormonal therapy is effective for treatment of prostate cancer, its effect in the treatment of metastatic spinal cord compression (MSCC) has not been established. The objective of this study was to clarify the efficacy of conservative treatment of MSCC-induced paralysis resulting from prostate cancer for patients without a previous treatment history. MethodsWe reviewed data from 38 patients with MSCC-induced paralysis from newly diagnosed prostate cancer who presented to our service between 1984 and 2010. Conservative treatment consisted of hormonal therapy with external radiation therapy (ERT). Patient demographic data, treatment details, involved spine MRI images, complications, and the course of neurologic recovery were investigated. ResultsTwenty-five patients were treated conservatively. Mean follow-up period was 36.8months. Sixteen patients (two with Frankel B, 14 with Frankel C) were unable to walk at initial presentation. After initiating conservative treatment, 75% (12 of 16) of these patients regained the ability to walk within 1month, 88% (14 in 16) did so within 3months, and all non-ambulatory patients did so within 6months. No one had morbid complications. Four patients who did not regain the ability to walk at 1month were found to have progressed to paraplegia rapidly, and tended to have severe compression as visualized on MRI, with a delay in the start of treatment in comparison with those who did so within 1month (21.0 vs. 7.8days). ConclusionsHormonal therapy associated with ERT is an important option for treatment of MSCC resulting from newly diagnosed prostate cancer.