Treatment of spinal cord compression: a retrospective analysis

Epidural spinal cord compression from metastatic disease is a common neurological complication of cancer. The incidence is probably increasing owing to continual advancements in the treatment of cancer that have led to prolongation of life and a greater probability of secondary involvement of the spinal cord. A problem often encountered by the oncologist treating patients with epidural spinal cord compression is the recurrence of compression by metastatic tumor both in and out of the original treatment field. Radiotherapists are often presented with the difficult task of trying to determine the optimal dose/time fractionation with the hope of improving the therapeutic ratio. We have examined the charts of 80 patients treated at the Rhode Island Hospital during the last five years (1975-1980) with myelographic evidence of cord compression in order to determine 1) the recurrence rate of cord compression by metastatic tumor after radiotherapy treatment both in and out of the original treatment field; 2) the influence of various dose/fractionation schedules on the disease-free interval; 3) the percentage of recurrence out of the treatment field that might represent "skipped lesions" at the original time of diagnosis. Our results show 1) that 9 patients (11.3%) experienced recurrence within the original treatment field; 2) that 21 (26.3%) experienced recurrence within the spinal canal, but out of the original treatment field; 3) that 9 of the 21 (42%) cases of recurrence out of the original treatment field occurred within 1 week and thus were determined to be "skipped lesions" at the time of diagnosis; and 4) that there appears to be a dose-response relationship for those patients treated successfully without recurrences who did not have presenting symptoms of complete paraplegia.