Treatment of Metastatic Epidural Spinal Cord Compression: The Goldilocks Principle

July 2, 2011|The Journal of Community and Supportive Oncology

Loblaw and Mitera are to be congratulated for their ongoing efforts to provide systematic guidelines in the palliative management of patients with malignant spinal cord compressions (MSCC). Highlighted in this review are recent reports that can help determine an appropriate radiotherapy (RT) dose. Loblaw and Mitera explore the various considerations important to the multidisciplinary team when reviewing treatment options. As a result of a lack of significant progress in the management of MSCC, unanswered questions remain.

References

1 E. Maranzano, F. Trippa, M. Casale, S. Costantini, M. Lupattelli, R. Bellavita, L. Marafioti, S. Pergolizzi, A. Santacaterina, M. Mignogna, G. Silvano and V. Fusco, 8Gy single-dose radiotherapy is effective in metastatic spinal cord compression: results of a phase III randomized multicentre Italian trial, Radiother Oncol 93 (2) (2009), pp. 174–179.

2 D. Rades, M. Lange, T. Veninga, V. Rudat, A. Bajrovic, L.J. Stalpers, J. Dunst and S.E. Schild, Preliminary results of spinal cord compression recurrence evaluation (SCORE-1) study comparing short-course versus long-course radiotherapy for local control of malignant epidural spinal cord compression, Int J Radiat Oncol Biol Phys 73 (1) (2009), pp. 228–234.

3 D. Rades, F. Fehlauer, R. Schulte, T. Veninga, L.J. Stalpers, H. Basic, A. Bajrovic, P.J. Hoskin, S. Tribius, I. Wildfang, V. Rudat, R. Engenhart-Cabilic, J.H. Karstens, W. Alberti, J. Dunst and S.E. Schild, Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression, J Clin Oncol 24 (21) (2006), pp. 3388–3393.

4 R.A. Patchell, P.A. Tibbs, W.F. Regine, R. Payne, S. Saris, R.J. Kryscio, M. Mohiuddin and B. Young, Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial, Lancet 366 (9486) (2005), pp. 643–648.

5 L.G. Soares and V.W. Chan, The rationale for a multimodal approach in the management of breakthrough cancer pain: a review, Am J Hospice Palliat Care 24 (5) (2007), pp. 430–439.

6 S. Ryu, M. Wang, P. Gerszten, F.-F. Yin and R. Timmerman et al. https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?action=openFile&FileID=4658.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Correspondence to: Harry Quon, MD, MS, Johns Hopkins University, Department of Radiation Oncology and Molecular Radiation Sciences, 401 North Broadway, Suite 1440 Baltimore, MD 21231-2410; telephone: (410) 502-3877; fax: (410) 502-1419

Vitae

Drs. Jones, McMenamin, and Quon are from the Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.