Treatment of spinal cord compression: are we overusing radiotherapy alone compared to surgery and radiotherapy?

Abstract

This article describes how patients with metastatic spinal cord compression (MSCC) were treated from 2005 to 2011 at a single institution. A comparison is made with an international and standardized scoring system which would have predicted which patients would have a better outcome with neurosurgery in addition to radiotherapy in accordance with current best practice standards. A retrospective audit of all MSCC patients presenting from 2005 to 2011 was undertaken. An assessment of outcome was made by using ambulatory assessment tool and by comparing overall survival with published standards. In all, 39 patients were identified, of whom 37 received radiotherapy alone and two (5%) received surgery and postoperative radiotherapy. The international standardized scoring system predicted 28 (72%) of the 39 patients might have had a better outcome with neurosurgery in addition to radiotherapy. MSCC patients generally had reasonable outcomes, but selected patients could potentially do better with decompressive surgery. There is a subset of MSCC patients who have poor predicted ambulatory rates after radiotherapy alone and who may benefit from decompressive surgery. It is recommended that MSCC patients be categorized according to the international scoring system to identify appropriate candidates for surgical intervention and postoperative radiotherapy or radiotherapy alone.