Best treatment for the immobilizing trauma of spinal cord compression in metastatic cancer

Cancer patients and their physicians have new answers as they seek the best treatment for the immobilizing trauma of spinal cord compression in metastatic cancer, thanks to Roy Patchell and colleagues at the University of Kentucky.

In this week's Lancet, Patchell's UK research team evaluate traditional surgical and radiation therapy options and conclude that direct decompressive surgery plus postoperative radiotherapy is more effective than either radiotherapy alone or other surgical options.

Metastatic epidural spinal cord compression (MESCC) is a debilitating and common complication of cancer, occurring in 5 to 14 percent of cancer patients. Standard treatment for MESCC consists of corticosteroids and radiotherapy – after which only 50 percent of patients are able to walk. Surgery, in the form of the simple laminectomy procedure used before the availability of radiotherapy, was largely abandoned as a treatment after a small randomized trial published in 1980 demonstrated no benefit of laminectomy alone or in conjunction with radiotherapy. However, the UK trial tested a more modern surgical treatment for MESCC, the direct decompressive surgical resection.

The results of the UK trial are definitive: direct decompressive surgery plus postoperative radiotherapy equal the best chances for regaining mobility in patients with metastatic cancer.

Patchell and his team found compelling results in a randomized, multi-institutional, non-blinded trial assessing the efficacy of surgery and radiotherapy combinations in more than 100 patients with spinal cord compression caused by metastatic cancer. Results were so statistically conclusive in favor of the direct decompressive surgery and radiotherapy combination that researchers halted the study after an interim analysis.

Eighty-four percent of patients who received both surgery and radiotherapy were able to walk after treatment, versus only 57 percent of patients who received only radiation. Patients in the surgery group also retained the ability to walk significantly longer after treatment, and were less dependent upon corticosteroids and opiod analgesics.