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Malignant extradural spinal cord compression in men with prostate cancer
1Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. andrew.loblaw@sunnybrook.ca
Current Opinion in Supportive and Palliative Care
|July 5, 2011
Summary
Malignant epidural spinal cord compression (MESCC) management requires individualized prognosis. For poor prognosis patients, single-fraction radiotherapy is effective and convenient, while good prognosis patients benefit from surgery and radiation.
Area of Science:
- Oncology
- Radiation Oncology
- Palliative Care
Background:
- Malignant epidural spinal cord compression (MESCC) is a serious complication of cancer, affecting approximately 7% of men with prostate cancer.
- Individualized treatment and accurate prognosis are crucial for balancing therapeutic effectiveness and patient burden.
Purpose of the Study:
- To review simple prognosis scales for clinicians managing MESCC.
- To outline optimal treatment strategies based on patient prognosis.
Main Methods:
- Review of available prognosis scales for MESCC.
- Analysis of randomized studies on radiotherapy fractionation schedules.
Main Results:
- For poor prognosis patients, a single 8 Gy fraction of radiotherapy is as effective as multiple fractions but more convenient.
- For good prognosis patients, combined surgery and radiation therapy are recommended.
Conclusions:
- Single-fraction radiotherapy offers a convenient and effective option for poor prognosis MESCC patients.
- Good prognosis patients should consider surgery and radiation; clinical trials comparing radiotherapy fractions are encouraged for those not undergoing surgery.
- Screening strategies are under development to help high-risk patients maintain ambulation.
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