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Metastatic Spinal Cord Compression (metastatic + spinal_cord_compression)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Metastatic spinal cord compression: an oncological emergency

EUROPEAN JOURNAL OF CANCER CARE, Issue 5 2009
IAIN LAWRIE mb, consultant in palliative medicine, mrcgp
This module considers the identification and management of metastatic spinal cord compression. [source]

Metastatic spinal cord compression: a review of practice and care

JOURNAL OF CLINICAL NURSING, Issue 13-14 2010
Lynn Kilbride
Aim and objectives., The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? Background., Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence-based guidelines which has been shown to cause delays and discrepancies in patient treatment. Design., A structured literature review to synthesise the available evidence about the management of MSCC. Methods., The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty-five articles were included. Results., The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered. Conclusion., Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike. Relevance to clinical practice., Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision-making of professional staff are of limited benefit. [source]

Metastatic spinal cord compression: an oncological emergency

Metastatic spinal cord compression: a review of practice and care

Validation and simplification of a score predicting survival in patients irradiated for metastatic spinal cord compression

CANCER, Issue 15 2010
Dirk Rades MD
Abstract BACKGROUND: Based on an analysis of 1852 retrospectively evaluated patients with metastatic spinal cord compression (MSCC), a scoring system was developed to predict survival. This study was performed to validate the scoring system in a new data set. METHODS: The score included 6 prognostic factors: tumor type, interval between tumor diagnosis and MSCC, other bone or visceral metastases, ambulatory status, and duration of motor deficits. Scores ranged between 20 and 45 points, and patients were initially divided into 5 groups: those with 20 to 25 points, those with 26 to 30 points, those with 31 to 35 points, those with 36 to 40 points, and those with 41 to 45 points. To facilitate the clinical use of the score, the patients were regrouped into 3 groups: those with 20 to 30 points, those with 31 to 35 points, and those with 36 to 45 points. In this study, data of 439 new patients were included who were divided into the same prognostic groups as in the preceding study. RESULTS: In this study, the 6-month survival rates were 7% (for those with 20-25 points), 19% (for those with 26-30 points), 56% (for those with 31-35 points), 73% (for those with 36-40 points), and 90% (for those with 41-45 points), respectively (P < .0001). After regrouping, the 6-month survival rates were 14% (for those with 20-30 points), 56% (for those with 31-35 points), and 80% (for those with 36-45 points), respectively, in this study (P < .0001). CONCLUSIONS: In the current study, the difference in 6-month survival between the prognostic groups was found to be as significant as in the preceding study. Thus, this scoring system was considered valid to estimate survival of MSCC patients. The system could have been simplified by including only 3 instead of 5 prognostic groups. Cancer 2010. © 2010 American Cancer Society. [source]

Prognostic factors for functional outcome and survival after reirradiation for in-field recurrences of metastatic spinal cord compression,

CANCER, Issue 5 2008
Dirk Rades MD
Abstract BACKGROUND. The purpose of the current study was to retrospectively investigate clinical outcome and potential prognostic factors after reirradiation (Re-RT) for in-field recurrence of metastatic spinal cord compression (MSCC). METHODS. Re-RT with 1 × 8 Gy (n = 48), 5 × 3 Gy (n = 29), 5 × 4 Gy (n = 30), 7 × 3 Gy (n = 3), 10-12 × 2 Gy (n = 11), or 17 × 1.8 Gy (n = 3) was administered to 124 patients. Cumulative biologically effective dose (BED) (first course of RT plus re-RT) ranged from 77.5 Gy2 to 142.6 Gy2, and was ,120 Gy2 in 114 (92%) patients. Twelve potential prognostic factors were investigated for associations with motor function and survival. RESULTS. Motor function improved in 45 (36%) patients, was stable in another 62 (50%) patients, and deteriorated in 17 (14%) patients. Upon multivariate analyses, the effect of Re-RT on motor function was significantly associated with the effect of the first course of RT (P = .048), Eastern Cooperative Oncology Group (ECOG) performance status (P = .020), time to development of motor deficits before Re-RT (P = .002), and visceral metastases (P < .001). Survival was associated with ECOG performance status (P < .001), ambulatory status before Re-RT (P < .001), time to development of motor deficits (P = .018), and visceral metastases (P <.001). Re-RT dose schedule or cumulative BED had no significant impact on functional outcome or survival. Acute toxicity was mild, and late toxicity, such as radiation myelopathy, was not observed. CONCLUSIONS. Given the limitations of a retrospective study and the relatively short follow up after Re-RT, spinal reirradiation appeared to be effective and safe when the cumulative BED is ,120 Gy2. Motor function after Re-RT was associated with the effect of first irradiation, performance status, time to development of motor deficits, and visceral metastases, whereas the Re-RT schedule had no significant impact. Cancer 2008. © 2008 American Cancer Society. [source]