Metastatic spinal cord compression: diagnostic delay, treatment, and outcome

Metastatic spinal cord compression (MSCC) is a disabling complication of malignant disease. The aim of this study was to estimate diagnostic delay, treatment outcome, and prognostic factors in patients with MSCC.

In 86 patients treated for MSCC at our institution, the median age was 65 years and there was a preponderance of males (73%). The median observation period was 39 months. Carcinoma of the prostate, lung, breast, and kidney constituted 66% of the primary malignancies. Prior to treatment, 34% had grade 1, 53% grade 2, and 13% grade 3 paresis. 33% underwent surgical laminectomy with postoperative radiotherapy (combined therapy), while 67% were irradiated only.

Median time from the start of symptoms to the first doctor contact was 1 day, and to hospital admission or treatment start 6 days and 8 days. The pre-treatment grade of paresis, preservation of gait function, and primary tumour histology were strong predictors for treatment response. Pain relief, reported by 82% of assessable patients, correlated to treatment response grade. Median survival from treatment start was 4.1 months. Survival corresponded positively to preserved gait function at admission, to treatment response grade, and to the employment of combined therapy. Primary tumour histology was an important predictor as breast cancer and prostate cancer had 3 to 6-fold longer survival compared to lung cancer patients.

Prolonged survival in a minority of the patients signified the importance of optimal treatment. To settle whether radiotherapy alone is the optimal treatment in all MSCC patients, a randomised trial is warranted.