Treatment Approach for Bilsky Grade 2 Metastatic Epidural Spinal Cord Compression Based on Radiation Therapy Failure...

Area of Science:

• Oncology
• Neurosurgery
• Radiation Oncology

Background:

• Metastatic epidural spinal cord compression (MESCC) is a common complication of cancer.
• Bilsky grade 2 MESCC represents a specific stage of spinal cord compression.
• Optimal initial treatment for Bilsky grade 2 MESCC remains a subject of investigation.

Purpose of the Study:

• To evaluate radiation therapy (RT) as an initial treatment for Bilsky grade 2 MESCC.
• To identify risk factors associated with RT failure in these patients.
• To compare outcomes between initial RT and surgical management.

Main Methods:

• Retrospective cohort study of 151 patients with Bilsky grade 2 MESCC.
• Comparison of patients initially treated with RT (n=127) versus surgery (n=24).
• Analysis of demographics, treatment outcomes, Spinal Instability Neoplastic Score (SINS), ambulatory status, and neurological function; logistic regression for RT failure predictors.

Main Results:

• RT was successful in 85.8% of patients; 14.2% required salvage surgery.
• Higher SINS (9.6 ± 3.2) were observed in the RT-failure group versus the RT-success group (7.4 ± 2.8, P=0.003).
• SINS >8 was a significant predictor of RT failure. Surgery patients were younger with more deficits.

Conclusions:

• RT is a viable initial treatment for Bilsky grade 2 MESCC without neurological deficits or severe pain.
• Patients with SINS >8 have increased risk of RT failure and may benefit from primary surgery.
• Initial treatment choice should consider spinal stability and neurological status.