Second occurrence of symptomatic metastatic spinal cord compression and findings of multiple spinal epidural metastases

Abstract

Purpose : To examine the frequency of initial multiple epidural metastases, and the occurrence of secondary spinal cord compression (SCC). Methods and Materials : To evaluate the frequency of a recurrent SCC after radiotherapy, and to compare among patients with single and multiple intraspinal metastases the risk of having a second SCC, we followed 107 patients with SCC from a histologically verified solid tumor prospectively with regular neurological examinations until death. Results : Multiple metastases were demonstrated in 37 (35%). Eight (7.5%) patients developed a second occurrence of SCC all in a new location within the spinal canal. The second occurrence of SCC was found with the same frequency in patients with single metastases (7.1%) compared to patients with multiple metastases (8.1%). The median survival time after the diagnosis of spinal cord compression was 3.4 months, while in the group of patients who developed a second occurrence of SCC the median survival time was 9.2 months. Conclusions : Only symptomatic epidurial metastases should be irradiated, and that all patients treated for SCC should be followed regularly and observed for development of a second SCC.