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Second occurrence of symptomatic metastatic spinal cord compression and findings of multiple spinal epidural
S Helweg-Larsen1, S W Hansen, P S Sørensen
1Department of Neurology, University Hospital of Copenhagen, Rigshospitalet, Denmark.
Purpose:
To examine the frequency of initial multiple epidural metastases, and the occurrence of secondary spinal cord compression (SCC).
Methods And Materials:
To evaluate the frequency of a recurrent SCC after radiotherapy, and to compare among patients with single and multiple intraspinal metastases the risk of having a second SCC, we followed 107 patients with SCC from a histologically verified solid tumor prospectively with regular neurological examinations until death.
Results:
Multiple metastases were demonstrated in 37 (35%). Eight (7.5%) patients developed a second occurrence of SCC all in a new location within the spinal canal. The second occurrence of SCC was found with the same frequency in patients with single metastases (7.1%) compared to patients with multiple metastases (8.1%). The median survival time after the diagnosis of spinal cord compression was 3.4 months, while in the group of patients who developed a second occurrence of SCC the median survival time was 9.2 months.
Conclusion:
Only symptomatic epidural metastases should be irradiated, and that all patients treated for SCC should be followed regularly and observed for development of a second SCC.