Metastatic Spinal Cord Compression Patients Research Articles

Six-Month Survivorship Prediction in Spinal Metastatic Patients by Oncologists Shows Reliable Prognostication.

A retrospective analysis of oncologist-provided prognoses vs actual survival outcomes of patients referred with Metastatic spinal cord compression (MSCC) to a supra-regional multidisciplinary team (MDT). Prognostic scoring systems, such as the revised Tokuhashi, are commonly used to help guide the treatment of MSCC. However, scoring systems do not accommodate for the improved outcomes of contemporary cancer therapy. Oncologist-provided prognoses play an important role in real world rapid decision making. There is a paucity of evidence assessing the accuracy of the oncologist-provided prognosis. We conducted a retrospective study to evaluate this. Data was captured between January 2015 and December 2018. Patients were split into 2 groups: Group 1 (prognosis estimated <6months) and Group 2 (prognosis estimated >6months). Median overall survival (mOS) and hazard ratio for death (HR) was assessed. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the oncologist's prognosis. 829 patients were included. mOS in Group 1 was 5.8 months (95% CI 4.2-7.4m), and in Group 2 mOS was not reached. Log rank test gave a Chi2 of 131 (P < .001). Cox regression analysis revealed a HR of .30 (P < .001). Area under the ROC curve was 78%. Oncologist-provided prognosis is accurate in this cohort of unselected, consecutive MSCC patients. It reduced reliance on scoring systems that can become outdated. Given the rapid progress in cancer treatment, the oncologist's prognostic prediction is integral in efficient and effective MSCC management to help rapidly determine surgical candidacy.

More help than harm: surgery for metastatic spinal cord compression is associated with more favorable overall survival within a propensity score analysis

PurposeIndication for surgical decompression in metastatic spinal cord compression (MSCC) is often based on prognostic scores such as the modified Bauer score (mBs), with favorable prognosis suggestive of surgery and poor prognosis of non-surgical management. This study aimed to clarify if (1) surgery may directly affect overall survival (OS) aside from short-term neurologic outcome, (2) explore whether selected patient subgroups with poor mBs might still benefit from surgery, and (3) gauge putative adverse effects of surgery on short-term oncologic outcomes.MethodsSingle-center propensity score analyses with inverse-probability-of-treatment-weights (IPTW) of OS and short-term neurologic outcomes in MSCC patients treated with or without surgery between 2007 and 2020.ResultsAmong 398 patients with MSCC, 194 (49%) underwent surgery. During a median follow-up of 5.8 years, 355 patients (89%) died. MBs was the most important predictor for spine surgery (p < 0.0001) and the strongest predictor of favorable OS (p < 0.0001). Surgery was associated with improved OS after accounting for selection bias with the IPTW method (p = 0.021) and emerged as the strongest determinant of short-term neurological improvement (p < 0.0001). Exploratory analyses delineated a subgroup of patients with an mBs of 1 point who still benefited from surgery, and surgery did not result in a higher risk of short-term oncologic disease progression.ConclusionThis propensity score analysis corroborates the concept that spine surgery for MSCC associates with more favorable neurological and OS outcomes. Selected patients with poor prognosis might also benefit from surgery, suggesting that even those with low mBs may be considered for this intervention.

Challenge or opportunity: Rehabilitation outcomes in patients with metastatic spinal cord compression – a UK single center experience

Context /Objective Metastatic Spinal Cord Compression (MSCC) is a devastating complication of cancer, affecting approximately 3000 patients per annum in England. However, access to rehabilitation services for MSCC patients is limited. The London Spinal Cord Injury Centre has set up a bespoke MSCC rehabilitation pathway from May 2013. This article aims to describe the clinical features and functional outcomes of patients with MSCC admitted to a Specialist Spinal Cord Injury Rehabilitation Centre between May 2013 and December 2021. Design Retrospective analysis of medical records from a single specialist rehabilitation centre database. Setting London Spinal Cord Injury Centre (LSCIC), Stanmore, United Kingdom. Participants Adult patients diagnosed with MSCC who were admitted to and discharged from LSCIC from May 2013 to December 2021. Interventions Specialist Inpatient Spinal Cord Injury Rehabilitation Program. Outcome Measures Spinal Cord Independence Measure 19 (SCIM version III), Discharge Destination. Results A total of 40 patients with MSCC were admitted – 32 male and 8 female patients. The average length of stay was 6 weeks. 17(42.5%) patients had primary prostate cancer. Most patients (34(85%)) had thoracic MSCC. There was an improvement in the Spinal Cord Independence Measure in all patients with an average significant improvement from 43.8 to 64.5 (P < 0.001). There was no significant difference in SCIM scores between patients under 65 and over 65. 28 (70%) patients required psychological input. 33(82.5%) patients were discharged home. Conclusion Patients with MSCC show improvement in SCIM outcome measures after a six-week inpatient Specialist Spinal Rehabilitation program.

Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome.

Simple SummarySpinal metastases affect an exceptionally high number of cancer patients and thereby represent a common challenge for healthcare providers. Patients may suffer from debilitating symptoms, including excruciating back pain, immobility and even neurological dysfunction. An exceptionally acute clinical presentation is caused by the compression of the spinal cord through growth of a spinal metastasis within the spinal canal, which may leave the patient with acute spinal cord injury in need of rapid surgical treatment. In clinical practice and science, no true timeframe has yet been defined within which these patients need to undergo surgery, although it is generally understood that their recovery and functional rehabilitation correlate with the time to surgery after symptom onset. In our study, we analyzed a surgically treated cohort of patients with acute spinal cord injury by metastatic compression to investigate the correlation of the timing of surgery with neurological recovery. We were able to identify a subgroup of patients with significantly improved recovery, in whom surgery was initiated within 16 h after admission. Complication rates were not significantly more frequent in this subgroup compared to patients operated on after 16 h. Based on these findings, we conclude that striving for surgery as early as feasible is a warranted strategy in patients with acute neurological deterioration due to metastatic spinal cord compression.Background: Patients with metastatic spinal cord compression (MSCC) may experience long-term functional impairment. It has been established that surgical decompression improves neurological outcomes, but the effect of early surgery remains uncertain. Our objective was to evaluate the impact of early versus late surgery for acute MSCC due to spinal metastases (SM). Methods: We retrospectively reviewed a consecutive cohort of all patients undergoing surgery for SMs at our institution. We determined the prevalence of acute MSCC; the time between acute neurological deterioration as well as between admission and surgery (standard procedure: decompression and instrumentation); and neurological impairment graded by the ASIA scale upon presentation and discharge. Results: We screened 693 patients with surgery for spinal metastasis; 140 patients (21.7%) had acute MSCC, defined as neurological impairment corresponding to ASIA grade D or lower, acquired within 72 h before admission. Non-MSCC patients had surgery for SM-related cauda equina syndrome, radiculopathy and/or spinal instability. Most common locations of the SM in acute MSCC were the thoracic (77.9%) and cervical (10.7%) spine. Per standard of care, acute MSCC patients underwent surgery including decompression and instrumentation, and the median time from admission to surgery was 16 h (interquartile range 10–22 h). Within the group of patients with acute MSCC, those who underwent early surgery (i.e., before the median 16 h) had a significantly higher rate of ASIA improvement by at least one grade at discharge (26.5%) compared to those who had late surgery after 16 h (10.1%; p = 0.024). Except for a significantly higher sepsis rate in the late surgery group, complication rates did not differ between the late and early surgery subgroups. Conclusions: We report data on the largest cohort of patients with MSCC to date. Early surgery is pivotal in acute MSCC, substantially increasing the chance for neurological improvement without increasing complication rates. We found no significant impact when surgery was performed later than 24 h after admission. These findings will provide the framework for a much-needed prospective study. Until then, the treatment strategy should entail the earliest possible surgical intervention.

The Utility of 'Minimal Access and Separation Surgery' in the Management of Metastatic Spine Disease.

Retrospective cohort study. To compare outcomes of percutaneous pedicle screw fixation (PPSF) to open posterior stabilization (OPS) in spinal instability patients and minimal access separation surgery (MASS) to open posterior stabilization and decompression (OPSD) in metastatic spinal cord compression (MSCC) patients. We analysed patients who underwent surgery for thoracolumbar metastatic spine disease (MSD) from Jan 2011 to Oct 2017. Patients were divided into minimally invasive spine surgery (MISS) and open spine surgery (OSS) groups. Spinal instability patients were treated with PPSF/OPS with pedicle screws. MSCC patients were treated with MASS/OPSD. Outcomes measured included intraoperative blood loss, operative time, duration of hospital stay and ASIA-score improvement. Time to initiate radiotherapy and perioperative surgical/non-surgical complications was recorded. Propensity scoring adjustment analysis was utilised to address heterogenicity of histological tumour subtypes. Of 200 eligible patients, 61 underwent MISS and 139 underwent OSS for MSD. There was no significant difference in baseline characteristics between MISS and OSS groups. In the MISS group, 28 (45.9%) patients were treated for spinal instability and 33 (54.1%) patients were treated for MSCC. In the OSS group, 15 (10.8%) patients were treated for spinal instability alone and 124 (89.2%) were treated for MSCC. Patients who underwent PPSF had significantly lower blood loss (95mL vs 564mL; P < .001) and surgical complication rates(P < .05) with shorter length of stay approaching significance (6 vs 19days; P = .100) when compared to the OPS group. Patients who underwent MASS had significantly lower blood loss (602mL vs 1008mL) and shorter length of stay (10 vs 18days; P = .098) vs the OPSD group. This study demonstrates the benefits of PPSF and MASS over OPS and OPSD for the treatment of MSD with spinal instability and MSCC, respectively.

PO-1462 Metastatic spinal compression referral patterns during pandemic lockdowns in Kent region UK

Purpose or Objective: Metastatic spinal cord compression (MSCC) is an oncological emergency with a potential for catastrophic neurological deficit. Once diagnosed, MSCC requires urgent treatment to avoid neurological disability. We looked at health-seeking behavioural changes in lockdown 1(L1) (March 23-June 24 2020) compared to the lockdown 2(L2) (Oct 25-Dec 2 2020) in England, UK. This study posited that incidence of MSCC in 2020 especially during L1, would increase due to: (i)reduced access to NHS resources due to the pandemic (ii) change in health-seeking behaviour due to perceived risk of COVID-19. (iii) changes to previously accepted practice with regards to systemic and radiotherapy treatment. Modelling studies have shown these factors led to a delay in diagnoses with increased late-stage presentations and cancer-related death. Following the national campaign that ensued due to decline in cancer diagnosis in L1, we hypothesized a reduction in MSCC presentations in L2, due to increased public health awareness and continued availability of cancer services, despite lockdown. Materials and Methods: A retrospective, multicentre analyses of MSCC cases across Kent was undertaken for year 2020. Year 2019 served as control. Study included all MSCC cases across the following NHS trusts (i) Maidstone and Tunbridge Wells (ii) Dartford and Gravesham (iii) East Kent University Hospital and (iv) Medway. Shapiro-Wilk was used to assess normality and unpaired T-test to compare referral numbers between 2019 vs 2020 and between L1 vs L2. p ≤0.05 was considered significant. Results: There were 134 MSCC cases in 2019 vs 193 in 2020. An average of 12 patients per month were treated in 2019 vs 17 in 2020, p=0.002 (fig 1). During L1, the average number of patients was 16 per month vs 11 in 2019 in the same period, p=0.08. For L2, it was 19 vs 11 respectively, p=0.10 (fig 2). More patients were offered single 8Gy fraction treatment in 2020 [77% (n=149) vs 66% (n=89)] (fig 2). (Figure Presented) Conclusion: There was an increase in the total number of MSCC in 2020 and in the average cases per month during lockdowns. This was expected given recent data showing delay in cancer diagnoses with an increase in late presentations. Though the number of MSCC was higher in L2 vs L1, there was a downward trend towards the end of L2. This may signify the positive impact of the national cancer campaign. Unfortunately, Kent region was badly hit with the new Covid 19 strain (B117) and most of the services were affected due to staff redeployment, sickness and isolation. Many patients with existing comorbidities are still anxious utilising hospital services due to perceived infection risk. Further work will be needed to reverse health-seeking behaviours to pre-pandemic levels. Focused cancer public health campaign may be required to allay patient fears and ensure safety, during use of vital health services. More single 8Gy fractions were delivered in 2020 compared to any previous years, indicating MSCC patients may now be scanned, planned and treated in one visit.

OC-0408 Higher-dose radiotherapy for metastatic spinal cord compression: First results of a phase II trial

Purpose or Objective To evaluate the outcomes after high-precison RT (preferably VMAT) with increased doses (EQD2 for tumors >40 Gy) when compared to 10x3 Gy (EQD2=32.5 Gy) for metastatic spinal cord compression (MSCC) in patients with favorable survival prognoses. Materials and Methods Since 08/2019, 29 (of 65) patients (9 female, 20 male) with motor deficits due to MSCC and a favorable survival prognosis according to a validated score have been included in a phase II trial (RAMSES-01). Median age is 68 (48-90) years, and most common tumor types are prostate cancer (n=10), breast cancer (n=7) and myeloma (n=6). RT regimens include 18x2.333 Gy (EQD2=43.2 Gy, n=10), 15x2.633 Gy (41.6 Gy, n=17;fewer fractions due to Covid-19 pandemic) and 12x2.663 Gy + 3x2.333 Gy (40.5 Gy, n=2;due to concurrent immunotherapy). Primary endpoint is local progression-free survival (LPFS=no progression of motor deficits during RT and no in-field recurrence following RT). Secondary goals include effect on motor function [improvement, overall response (OR) = at least no further progression] and sensory deficits, pain relief, overall survival (OS) and toxicity. Follow-up (FU) is performed until death or for 12 months. Results Three patients are currenty under treatment, one patient died after 14 Gy. Thus, 25 patients are evaluable for LPFS and response. LPFS is 100% at the end of RT (currently n=25), and at 1 month (n=21), 3 months (n=16), 6 months (n=9), 9 months (n=5) and 12 months (n=3) following RT. Considering best response during FU, OR and improvement rates are 100% and 60%, respectively. Sensory function normalized in 5 of the 9 patients (55.6%) with pre-RT sensory dysfunction. Of 21 patients with pain (median score 8, range 4-10), 18 (86%) achieved pain relief [complete in 7 patients (33%)]. OS-rates at 6 and 12 months are 71% and 71%, respectively. Six patients died (3 sepsis, 2 pneumonia, 1 tumor progression);death was not related to RT. RT-related grade 3 toxicity occurred in 2/25 (8%) patients (1 esophagitis, 1 diarrhea). Conclusion First results of high-precision RT with increased doses for MSCC in patients with favorable survival prognoses appear very promising with high response and LPFS rates and very few grade 3 toxicities. Updated information will be presented at the meeting.

Reversing the Friday peak in metastatic cord compression referrals: Not as simple as previously thought?

e14050 Background: Historically, metastatic spinal cord compression (MSCC) referrals trend towards a Friday peak in incidence (Koiter E, Radioth Onc 2013). However, data from a single, tertiary centre in the UK showed a reversal in the Friday peak (Adeleke S, Annals of Oncology 2020). This was attributed to early case referrals and quicker treatment decisions. In this new study, we explored whether a similar pattern was apparent in multiple district general hospital (DGH) settings and attempt to identify underlying causes. DGHs manage a larger proportion of cancer patients in the UK. Methods: 1,069 patients between 1 Jan 2015 and 31 Dec 2020 were identified across 4 hospitals in Kent, UK with a population of 1.6 million people. 220, 181, 182, 159, 134 and 193 MSCC patients were identified annually (2015-2020). Commonest cancers were prostate (24.1%), lung (19.3%) and breast (12.3%). Thoracic and lumbar regions constituted 80% of MSCC sites. Kruskal Wallis was used to compare differences in referrals across weekdays. Data was then dichotomised to Fridays only vs. other days of the week combined, as previously reported (De Bono B, Acta Neurochir 2019). Chi squared was used to compare frequency of referrals between the two groups. Chi squared goodness of fit test was conducted to detect if Friday reflected the day with highest referrals across the week. Results: Across the region, 2015 saw the highest number of Friday referrals relative to other days, p= 0.002. Friday referrals continued to drop, year on year, until 2018 with a corresponding increase in mid-week referrals. After 2018, there was a return in trend to a further Friday peak across the region, though p= 0.836. On an individual hospital basis, the persistent Friday peak in the region was driven by two hospitals. Having a 7-day acute oncology service (AOS), 7-day radiology reporting and single referral point of contact in the department, were factors identified that kept the referrals across the week uniform. On another note, a substantial shift towards a single 8Gy fraction vs. 20Gy in 5 fractions was observed across the region. This change coincided with SCORAD III data (Hoskin P, ASCO 2017) and demonstrates adherence to evidence-based practice in the region. Conclusions: This large multi-centre retrospective study shows a differential referral pattern in the region, with hospitals with 7-day AOS/Radiology reporting and single point of referral (e.g, similar to MSCC coordinator role) having a quicker treatment turnaround and uniform referrals across the week. The MSCC coordinator has been shown to streamline service, ensure timely decision-making and improved survival outcomes (Richards L, Spine J 2017). The role is recommended by NICE UK. DGHs should consider appointing an MSCC coordinator when designing/auditing their service. The shift towards single 8Gy fraction can provide a ‘one-stop’ service where patients are scanned, planned and treated on the same day.

115 An Audit on Dexamethasone Prescribing Practice on Surgically Managed Metastatic Spinal Cord Compression Patients in the Manchester Centre for Clinical Neurosciences: Lessons Learned in Closing the Loop

Abstract Metastatic Spinal Cord Compression is a surgical emergency owing to its propensity to cause significant morbidity and mortality. Dexamethasone is prescribed to reduce oedema and promote vascular membrane stabilization. The is done so until a more definitive management has been performed. This is a retrospective study evaluating the steroid-prescribing practice for MSCC patients in 2018 at a tertiary spinal unit in Greater Manchester. Thirty-three patients who underwent stabilisation were evaluated in terms of both steroid prescribing and weaning practices. Standards used against for both were the NICE guidelines and the Edinburgh/Christie’s guidelines. Of the 33 patients evaluated, only 1 patient received the correct loading dose of 16mg, whilst 27 went straight to being given 8mg BD. 5 did not receive dexamethasone at all. In terms of discontinuation/weaning, 26 were weaned accordingly and 2 were not weaned to continue as adjuvant treatment. Dexamethasone prescribing practises has since improved over the past two years. 93% of the patients have been correctly weaned as compared to 38% in the past. In terms of prescription, much needs to be done as almost all the patients evaluated did not get the correct loading dose despite receiving the appropriate maintenance.

Predictive Value of the Spinal Instability Neoplastic Score for Survival and Ambulatory Function After Surgery for Metastatic Spinal Cord Compression in 110 Patients with Prostate Cancer.

We retrospectively analyzed Spinal Instability Neoplastic Score (SINS) in 110 patients with prostate cancer operated for metastatic spinal cord compression (MSCC). We aimed to investigate the association between SINS and clinical outcomes after surgery for MSCC in patients with prostate cancer. The SINS is a useful tool for assessing tumor-related spinal instability, but its prognostic value regarding survival and neurological outcome is still controversial. We analyzed 110 consecutive patients with prostate cancer who underwent surgery for MSCC. The patients were categorized according to their SINS. Patients with castration-resistant prostate cancer (CRPC, n = 84) and those with hormone-naïve disease (n = 26) were analyzed separately. In total, 106 of 110 patients met the SINS criteria for potential instability or instability (scores 7-18). The median SINS was 10 (range 6-15) for patients with CRPC and 9 (7-16) for hormone-naïve patients. In the CRPC group, the SINS was classified as stable (score 0-6) in 4 patients, as potentially unstable (score 7-12) in 70 patients, and as unstable (score 13-18) in 10 patients. In the hormone-naïve group, 22 patients met the SINS criteria for potential instability and 4 patients for instability. There was no statistically significant difference in the overall risk for death between the SINS potentially unstable and unstable categories (adjusted hazard ratio 1.3, P = 0.4), or in the risk of loss of ambulation 1 month after surgery (adjusted odds ratio 1.4, P = 0.6). The SINS is helpful in assessing spinal instability when selecting patients for surgery, but it does not predict survival or neurological outcomes. Patients with a potential spinal instability benefit equally from surgery for MSCC as do patients with spinal instability.Level of Evidence: 3.

Minimal Access vs. Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One-Center Randomized Controlled Trial.

We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC). A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing. The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing. The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.

Nursing considerations for supporting cancer patients with metastatic spinal cord compression: a literature review.

metastatic spinal cord compression (MSCC) is an oncology emergency. Prevalence is increasing. Treatment and care are complex and those diagnosed may be faced with life-changing challenges. to review the impact and management of MSCC in patients with cancer, in order to analyse nursing considerations for supporting patients. a literature review and thematic analysis of five primary research papers, published between 2009 and 2014. two themes of prognosis/survival time and independence versus dependence were discovered. the onset of MSCC may result in paralysis and associated loss of independence, impacting on a patient's quality of life. Understanding individuals' prognosis and treatment/care preferences is fundamental for the sensitive, individualised support of patients with MSCC. The findings reinforce the nurses' role in health education, in order to raise awareness of MSCC and promote early diagnosis so that patients maintain function and independence as long as possible. The findings support the need for nurses to be equipped with appropriate communication skills to initiate and engage in sensitive, difficult and proactive conversations with patients and their families, supporting the delivery of humanised care.

Metastatic spinal cord compression (MSCC) treated with palliative decompression: Surgical timing and survival rate.

BackgroundMetastatic spinal cord compression (MSCC) treatment depends on life expectancies. Data regarding palliative decompression outcomes is scarce. We demonstrate that surgical timing has a significant impact on survival in MSCC patients treated with palliative decompression.MethodsEighty-nine consecutive MSCC patients at a tertiary referral medical center were enrolled between January 2012 and February 2016. Wide laminectomy was performed for tumors invading the vertebral body. Debulking surgery was done for tumors damaging the posterior column of the spine. Patient records were retrospectively analyzed.ResultsBetter survival was observed in patients with preoperative intact motor function (Group A, n = 37) than in those with motor deficit (Group B, n = 52, p = 0.0031). In Group B, survival was better in those who underwent surgery within 7 days of motor deficit onset than in those who underwent surgery 7 days after onset (p = 0.0444) and in postoperative ambulant patients than in nonambulant patients (p = 0.0120). In Group B, Frankel grade improved in patients who underwent surgery within 48 h than in those who underwent surgery after 48 h (p = 0.0992). Group A patients had a shorter hospital stay and higher revised Tokuhashi score than Group B patients. Overall survival was better in patients with a lower Tomita score (≤5, p = 0.0012), higher revised Tokuhashi score (≥9, p = 0.0009), better preoperative Frankel grade (p < 0.0001), and younger age (≤55 years, p = 0.0179). There were no significant differences in age, sex, tumor type, involved vertebrae level, Tomita score, intraoperative blood loss, operation time, incidence of infection, and postoperative complications between groups.ConclusionWe can improve the survival of MSCC patients with palliative decompression before motor deficits occur. After motor deficit onset, survival can still be improved with surgery within 7 days. Overall survival was better in patients aged ≤55 years.

Outcomes of metastatic spinal cord compression secondary to primary hepatocellular carcinoma with multidisciplinary treatments

Few studies have reported progression-free survival (PFS) and overall survival (OS) of Metastatic spinal cord compression (MSCC) patients with primary hepatocellular carcinoma (HCC) following surgery and adjuvant therapies. Enrolled in this study were 155 MSCC patients with primary HCC who received surgery and adjuvant therapies between 2000 and 2015. Kaplan-Meier methods and Cox’s proportional hazards regression mode were performed to investigate the clinical features and prognostic factors affecting PFS and OS. The median PFS and OS was 7.0 months and 9.7 months, respectively. 92.9% patients responded well to surgery according to the Visual Analogue Scale, Frankel Score and postoperative complication occurrences. 68 (43.9%) patients who received circumferential decompression achieved better PFS than the remaining 87 (56.1%) patients who received laminectomy. Favorable outcomes were achieved after surgery during the perioperative period. Circumferential decompression was associated with better PFS than laminectomy. The postoperative Frankel Score E, Eastern Cooperative Oncology Group performance score of 1 or 2, no visceral metastasis, administration of postoperative radiation and the use of Sorafenib were found to be significant predictors of better PFS and OS. Patients who previously underwent resection of primary HCC with/without liver transplantation tended to have a better OS.

Preoperative embolization in patients with metastatic spinal cord compression: mandatory or optional?

BackgroundThe contribution of preoperative embolization in reducing intraoperative blood loss and its clinical importance are unclear. So, we aimed to compare the perioperative clinical outcomes based on whether preoperative embolization was performed and assess the role and safety of preoperative embolization in metastatic spinal cord compression (MSCC) patients.MethodsWe enrolled 52 patients (men, 37; women, 15) who underwent palliative decompression for MSCC. Demographic data, neurologic status, surgery-related data (operation time, estimated blood loss, and transfusion), complications, and survival time were recorded. Patients were categorized based on whether they received preoperative embolization: groups E (embolization) (n = 18) and NE (non-embolization) (n = 34) and the clinical parameters were compared. Subgroup analysis was performed specifically for cases of hypervascular tumors (23/52, 44%).ResultsThe transfusion degree was greater in the NE group (4.6 pints) than in the E group (2.5 pints, P = 0.025); the other parameters did not differ between the groups. However, massive bleeding (>2000 mL) was more frequent in the NE group (10/34) than in the E group (0/18, P = 0.010). Subgroup analysis indicated that intraoperative blood loss was greater in the NE group (1988 mL) than in the E group (1095 mL, P = 0.042) in hypervascular tumor patients. Although massive bleeding was more frequent among hypervascular tumor patients, 3 patients with non-hypervascularized tumors also exhibited massive bleeding (P = 0.087).ConclusionsIntraoperative blood loss and perioperative transfusion can be reduced by preoperative embolization in MSCC patients. Neurologic recovery, operation time, and complications did not differ according to the application of embolization. As preoperative embolization is relatively safe and effective for controlling intraoperative bleeding without any neurologic deterioration, it is highly recommended for hypervascular tumors. Moreover, it may also be effective for non-hypervascular tumors as massive bleeding may be noted in some cases.

86 - Metastatic Spinal Cord Compression (MSCC) – Collaborative Work between the Tertiary Cancer Centre and the Specialist Spinal Centre Since the Introduction of the MSCC Coordinator Service Has Seen a Marked Increase in Surgical Rates, with 20% of Patients Who Presented with MSCC in the First 24 Months Having Spinal Surgery. This Has Resulted in Improved Survival Rates for

86 - Metastatic Spinal Cord Compression (MSCC) – Collaborative Work between the Tertiary Cancer Centre and the Specialist Spinal Centre Since the Introduction of the MSCC Coordinator Service Has Seen a Marked Increase in Surgical Rates, with 20% of Patients Who Presented with MSCC in the First 24 Months Having Spinal Surgery. This Has Resulted in Improved Survival Rates for

Who are the Best Candidates for Decompressive Surgery and Spine Stabilization in Patients With Metastatic Spinal Cord Compression?: A New Scoring System.

Study Design.A retrospective study.Objective.This study aims to develop a new scoring system that can guild surgeons to select the best candidates for decompressive surgery in patients with metastatic spinal cord compression (MSCC).Summary of Background Data.Predicting survival and functional outcome is essential when selecting the individual treatment for patients with MSCC. The criteria for identifying MSCC patients who are most likely to benefit from decompressive surgery remain unclear.Methods.We retrospectively analyzed 12 preoperative characteristics for postoperative survival in a series of 206 patients with MSCC who were operated with decompressive surgery and spine stabilization. Characteristics significantly associated with survival in the multivariate analysis were included in the scoring system. Postoperative function outcome was also analyzed on the basis of the scoring system.Results.According to the multivariate analysis, primary site (P < 0.01), preoperative ambulatory status (P < 0.01), visceral metastases (P < 0.01), preoperative chemotherapy (P = 0.02), and bone metastasis at cancer diagnosis (P = 0.03) had a significant impact on postoperative survival and were included in the scoring system. According to the prognostic scores, which ranged from 0 to 10 points, three risk groups were designed: 0 to 2, 3 to 5, and 6 to 10 points. The corresponding 6 months survival rates were 8.2%, 56.5%, and 91.5%, respectively (P < 0.01), and postoperative ambulatory rates were 35.7%, 73.3%, and 95.9%, respectively (P < 0.01).Conclusion.We present a new scoring system for predicting survival and function outcome of MSCC patients after surgical decompression and spine stabilization. This new scoring system can help surgeons select the best candidates for surgical treatment.Level of Evidence: 4

Individual strategy for lung cancer patients with metastatic spinal cord compression

PurposeThe criteria for identifying lung cancer patients with metastatic spinal cord compression (MSCC) who may benefit from decompressive surgery remains unclear. This study aims to create a new therapeutic strategy which can guild surgeons to select the individual treatment for MSCC patients from lung cancer. MethodsWe retrospectively assessed 73 consecutive lung cancer patients who were treated with decompressive surgery for MSCC. Twelve preoperative characteristics were analyzed for postoperative survival. Characteristics significantly associated with survival in the multivariate analyses were included in a scoring system. The total score for each patient was obtained by adding the scoring points of all significant characteristics. Postoperative function outcome was also analyzed according to prognostic groups. ResultsIn the multivariate analyses, preoperative ambulatory status (P = 0.02), targeted therapy (P = 0.01), number of involved vertebrae (P < 0.01), visceral metastases (P < 0.01), and time developing motor deficits (P < 0.01) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 15 to 35 points, three prognostic groups were designed: 15–23 points (n = 32), 25–29 points (n = 26), and 31–35 points (n = 15). The corresponding median survival times were 2.6 months (95% CI, 1.5–4.3 months), 7.2 months (95% CI, 6.0–10.8 months) and 13.2 months (95% CI, 8.8–18.7 months), respectively (P < 0.01), and the corresponding postoperative ambulatory rates were 46.9%, 80.8%, and 93.3%, respectively (P < 0.01). ConclusionWe present a scoring system for lung cancer patients with MSCC after surgery based on survival and functional outcome. The scoring system can guild surgeons to select the individual strategy for patients with MSCC from lung cancer.

Preoperative Scoring and Limits of Prognostication: Functional Outcome after Surgical Decompression in Metastatic Spinal Cord Compression

Objective: To determine whether preoperative parameters correlate with the postoperative functional outcome in para- and tetraplegic patients with lung, kidney, breast and prostate cancer and metastatic spinal cord compression (MSCC). Methods: Information on 43 patients undergoing decompressive surgery and rehabilitation for MSCC was reviewed, including primary tumor, age, pre- and postoperative ambulation status, mobility subcategory of the Spinal Cord Injury Measure (mSCIM) and the Tokuhashi score. Differences between groups were analyzed by the nonparametric χ² test, and correlation coefficients (Spearman's rho) were computed. Results: Preoperative ambulation (p < 0.001), the American Spinal Injury Association Impairment Scale (p < 0.001) and the type of operation (p = 0.02) influenced the postoperative functional outcome. Any positive change in the mSCIM was influenced by preoperative ambulation (p < 0.001). Patients with breast carcinoma showed significantly more positive changes in the mSCIM compared with other tumors (p = 0.002). No correlation was found between the treatment categories of the Tokuhashi score and the preoperative ambulatory status (p = 0.13) or the change in ambulation status (p = 0.29). Conclusion: The postoperative functional outcome of MSCC patients shows a linear association between the categories of the Tokuhashi score and the change in ambulation status. We recommend surgical decompression even in a palliative situation (Tokuhashi score 0-8) with the aim of optimizing the short-term rehabilitation outcome. © 2014 S. Karger AG, Basel

A Study of the Predictive Value of the Modified Tokuhashi Score in Metastatic Spinal Tumour Causing Cord Compression in a Southern Chinese Population

IntroductionIt is generally agreed that operative intervention is beneficial in carefully selected groups of patients with metastatic spinal cord compression (MSCC). Tokuhashi et al have presented a preoperative scoring system to predict patient survival, which is widely used as a guideline for making a decision on whether to operate or not. However, only limited data are available regarding the validity of the Tokuhashi score in Southern Chinese populations. Materials and methodsWe report a series of 128 patients treated in our hospital from 2000 to 2010. All patients were diagnosed to have spinal metastasis of different origins with cord compression. Of the 128, 59 underwent operation and the remaining 69 received conservative treatments. The Tokuhashi score was then calculated retrospectively. The survival rate was analysed and p < 0.05 was considered statistically significant. ResultsIn our series, the accuracy of the modified Tokuhashi scoring for predicting the survival rate in patients with MSCC was demonstrated to be 79% (101/128). The poor prognostic group showed statistically significant worse survival than the two better prognostic groups. The type of primary cancer (p = 0.0015), visceral metastasis (p = 0.006), and the general condition (p < 0.001) were confirmed as significant survival prognostic factors. Nasopharyngeal carcinoma (NPC) had the most favourable outcome with a mean survival of 20.1 months. ConclusionThe modified Tokuhashi score was statistically correlated to the overall survival of MSCC patients in a Southern Chinese population. The type of primary cancer, visceral metastasis, and the general condition were statistically significant survival factors. We recommend weighting a higher score for NPC in the modified Tokuhashi scoring system in view of its favourable prognosis.