Malignant Spinal Cord Compression: Highlights on Specific Management Aspects

Malignant spinal cord compression is a common oncological emergency. Three cases are presented to illustrate some important management aspects of malignant spinal cord compression. In general, the definitive treatment of malignant spinal cord compression depends on the patient’s performance status, the life expectancy and the type of malignancy. Radiotherapy is the mainstay of treatment. Single fraction or short radiotherapy courses have been shown to give similar functional outcome as compared with long radiotherapy courses but with more in-field recurrence rates. The choice of fractionation of radiotherapy is also based on the patient’s performance or functional status, the estimated life expectancy and the cancer types. Early diagnosis and prompt treatment of malignant spinal cord compression before manifestation of neurological deficits is crucial to preserve the neurological function. High awareness of the risk factors and any suspicious back pain are essential to detect spinal cord compression at the impending state. After irradiation, in-field recurrence of malignant spinal cord compression is not uncommon. Limited number of studies have shown good functional outcome of re-irradiation. Re-irradiation can be considered for an in-field recurrence of spinal cord compression at the irradiated area in selected patients. HKSPM Newsletter 2008 April Issue 1 p 21-25. Palliative Medicine Doctors’ Meeting__________________________HKSPM Newsletter 2008 Apr Issue 1 p 22 Due to the extensive disease, surgery was deemed not feasible. In view of the patient’s good performance status and good prerecurrence functional status, a second course of radiotherapy to levels T10 to T12 was subsequently given. A total dose of 24Gy were given in 8 fractions. Mr. B’s lower limb power improved after the second course of radiotherapy. He remained fully ambulatory for the remaining six months of his life.