Surgical resection improves outcome in metastatic epidural spinal cord compression

Abstract

In today's Lancet, Roy Patchell and colleagues 1 Patchell RA Tibbs PA Regine WF et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005; DOI:10.1016/S0140-6736(05)66954-1 PubMed Google Scholar present the long awaited outcome of a randomised trial of decompressive surgical resection in patients with metastatic epidural spinal cord compression (MESCC), which will have a major effect on the therapeutic approach to these patients. MESCC is a great threat for all cancer patients with vertebral body metastases, which can lead to paraplegia. The current standard of care consists of a high level of suspicion toward cancer patients with back pain, a low threshold for performing MRI, and immediate radiotherapy in cases of spinal cord compression. Once paraplegia develops the outlook for the patient is grim. Not only does paraplegia severely affect quality of life, but the functional response to radiotherapy mainly depends on the ambulatory status of the patient at the start of treatment: most ambulant patients will remain ambulant, but non-ambulant patients rarely recover to an ambulant status and have a very limited survival. 2 Helweg-Larsen S Sorensen PS Kreiner S Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients. Int J Radiat Oncol Biol Phys. 2000; 46: 1163-1169 Summary Full Text Full Text PDF PubMed Scopus (216) Google Scholar Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trialDirect decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer. Full-Text PDF Open Access