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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1992 Dec;55(12):1188–1193. doi: 10.1136/jnnp.55.12.1188

Early diagnosis and treatment of spinal epidural metastasis in breast cancer: a prospective study.

W Boogerd 1, J J van der Sande 1, R Kröger 1
PMCID: PMC1015337  PMID: 1479399

Abstract

This prospective study evaluated the usefulness of myelography in breast cancer patients who present with radiculopathy or myelopathy. A total of 124 consecutive myelograms were performed in 100 patients. Epidural metastasis (EM) was diagnosed in 67 myelograms (54%). Multiple epidural metastases were diagnosed in 15 (22%) of those, resulting in a total of 87 epidural lesions. A complete block was found in 13 EM (15%) and an incomplete block in 14 EM (16%). Clinical data could not predict the site of EM in 29 cases (33%). Fifteen asymptomatic EM were detected in myelograms with multiple EM. Plain radiographs were of no value in determining the site of EM in 29 cases (33%), including 13 cases (15%) without vertebral metastasis at the site of EM. Treatment consisted of radiotherapy (RT) with or without systemic treatment in 52 cases (80%), systemic treatment alone in 11 cases (17%) and surgery in two patients (3%). Clinical improvement was noticed in 72%, no change in 13%, and deterioration in 15%. No difference in response was noticed between RT and systemic therapy. Before treatment 21% and after treatment 15% of the patients could not walk. The one year survival was 42%. The ambulatory status at presentation was the most important prognostic factor. Examination of the spinal fluid, obtained at myelography, disclosed meningeal carcinomatosis in 9% of the patients. Imaging of the whole spinal canal with cytological examination of the spinal fluid is recommended in breast cancer patients suspected of epidural tumour with features of radiculopathy or myelopathy, irrespective of further clinical data and plain spinal radiographs.

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Selected References

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  1. BARRON K. D., HIRANO A., ARAKI S., TERRY R. D. Experiences with metastatic neoplasms involving the spinal cord. Neurology. 1959 Feb;9(2):91–106. doi: 10.1212/wnl.9.2.91. [DOI] [PubMed] [Google Scholar]
  2. Bernat J. L., Greenberg E. R., Barrett J. Suspected epidural compression of the spinal cord and cauda equina by metastatic carcinoma. Clinical diagnosis and survival. Cancer. 1983 May 15;51(10):1953–1957. doi: 10.1002/1097-0142(19830515)51:10<1953::aid-cncr2820511035>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  3. Black P. Spinal metastasis: current status and recommended guidelines for management. Neurosurgery. 1979 Dec;5(6):726–746. doi: 10.1227/00006123-197912000-00016. [DOI] [PubMed] [Google Scholar]
  4. Bonner J. A., Lichter A. S. A caution about the use of MRI to diagnose spinal cord compression. N Engl J Med. 1990 Feb 22;322(8):556–557. doi: 10.1056/NEJM199002223220817. [DOI] [PubMed] [Google Scholar]
  5. Boogerd W., van der Sande J. J., Kröger R., Bruning P. F., Somers R. Effective systemic therapy for spinal epidural metastases from breast carcinoma. Eur J Cancer Clin Oncol. 1989 Jan;25(1):149–153. doi: 10.1016/0277-5379(89)90066-7. [DOI] [PubMed] [Google Scholar]
  6. Constans J. P., de Divitiis E., Donzelli R., Spaziante R., Meder J. F., Haye C. Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg. 1983 Jul;59(1):111–118. doi: 10.3171/jns.1983.59.1.0111. [DOI] [PubMed] [Google Scholar]
  7. Dunn R. C., Jr, Kelly W. A., Wohns R. N., Howe J. F. Spinal epidural neoplasia. A 15-year review of the results of surgical therapy. J Neurosurg. 1980 Jan;52(1):47–51. doi: 10.3171/jns.1980.52.1.0047. [DOI] [PubMed] [Google Scholar]
  8. Fidler M. W. Anterior decompression and stabilisation of metastatic spinal fractures. J Bone Joint Surg Br. 1986 Jan;68(1):83–90. doi: 10.1302/0301-620X.68B1.3941146. [DOI] [PubMed] [Google Scholar]
  9. Fornasier V. L., Horne J. G. Metastases to the vertebral column. Cancer. 1975 Aug;36(2):590–594. doi: 10.1002/1097-0142(197508)36:2<590::aid-cncr2820360240>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  10. Gilbert R. W., Kim J. H., Posner J. B. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978 Jan;3(1):40–51. doi: 10.1002/ana.410030107. [DOI] [PubMed] [Google Scholar]
  11. Greenberg H. S., Kim J. H., Posner J. B. Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol. 1980 Oct;8(4):361–366. doi: 10.1002/ana.410080404. [DOI] [PubMed] [Google Scholar]
  12. Hagenau C., Grosh W., Currie M., Wiley R. G. Comparison of spinal magnetic resonance imaging and myelography in cancer patients. J Clin Oncol. 1987 Oct;5(10):1663–1669. doi: 10.1200/JCO.1987.5.10.1663. [DOI] [PubMed] [Google Scholar]
  13. Harrington K. D. Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg. 1984 Jul;61(1):107–117. doi: 10.3171/jns.1984.61.1.0107. [DOI] [PubMed] [Google Scholar]
  14. Harrison K. M., Muss H. B., Ball M. R., McWhorter M., Case D. Spinal cord compression in breast cancer. Cancer. 1985 Jun 15;55(12):2839–2844. doi: 10.1002/1097-0142(19850615)55:12<2839::aid-cncr2820551222>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  15. Hollis P. H., Malis L. I., Zappulla R. A. Neurological deterioration after lumbar puncture below complete spinal subarachnoid block. J Neurosurg. 1986 Feb;64(2):253–256. doi: 10.3171/jns.1986.64.2.0253. [DOI] [PubMed] [Google Scholar]
  16. Kelly W. M., Badami P., Dillon W. Epidural block: myelographic evaluation with a single-puncture technique using metrizamide. Radiology. 1984 May;151(2):417–419. doi: 10.1148/radiology.151.2.6709912. [DOI] [PubMed] [Google Scholar]
  17. Livingston K. E., Perrin R. G. The neurosurgical management of spinal metastases causing cord and cauda equina compression. J Neurosurg. 1978 Dec;49(6):839–843. doi: 10.3171/jns.1978.49.6.0839. [DOI] [PubMed] [Google Scholar]
  18. Loeffler J. S., Glicksman A. S., Tefft M., Gelch M. Treatment of spinal cord compression: a retrospective analysis. Med Pediatr Oncol. 1983;11(5):347–351. doi: 10.1002/mpo.2950110511. [DOI] [PubMed] [Google Scholar]
  19. Maranzano E., Latini P., Checcaglini F., Ricci S., Panizza B. M., Aristei C., Perrucci E., Beneventi S., Corgna E., Tonato M. Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients. Cancer. 1991 Mar 1;67(5):1311–1317. doi: 10.1002/1097-0142(19910301)67:5<1311::aid-cncr2820670507>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  20. O'Rourke T., George C. B., Redmond J., 3rd, Davidson H., Cornett P., Fill W. L., Spring D. B., Sobel D., Dabe I. B., Karl R. D., Jr Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease. J Clin Oncol. 1986 Apr;4(4):576–583. doi: 10.1200/JCO.1986.4.4.576. [DOI] [PubMed] [Google Scholar]
  21. Redmond J., 3rd, Friedl K. E., Cornett P., Stone M., O'Rourke T., George C. B. Clinical usefulness of an algorithm for the early diagnosis of spinal metastatic disease. J Clin Oncol. 1988 Jan;6(1):154–157. doi: 10.1200/JCO.1988.6.1.154. [DOI] [PubMed] [Google Scholar]
  22. Rodichok L. D., Harper G. R., Ruckdeschel J. C., Price A., Roberson G., Barron K. D., Horton J. Early diagnosis of spinal epidural metastases. Am J Med. 1981 Jun;70(6):1181–1188. doi: 10.1016/0002-9343(81)90825-1. [DOI] [PubMed] [Google Scholar]
  23. Rodichok L. D., Ruckdeschel J. C., Harper G. R., Cooper G., Prevosti L., Fernando L., Baxter D. H. Early detection and treatment of spinal epidural metastases: the role of myelography. Ann Neurol. 1986 Dec;20(6):696–702. doi: 10.1002/ana.410200608. [DOI] [PubMed] [Google Scholar]
  24. Ruff R. L., Lanska D. J. Epidural metastases in prospectively evaluated veterans with cancer and back pain. Cancer. 1989 Jun 1;63(11):2234–2241. doi: 10.1002/1097-0142(19890601)63:11<2234::aid-cncr2820631130>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  25. Siegal T., Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery. 1985 Sep;17(3):424–432. doi: 10.1227/00006123-198509000-00005. [DOI] [PubMed] [Google Scholar]
  26. Stark R. J., Henson R. A., Evans S. J. Spinal metastases. A retrospective survey from a general hospital. Brain. 1982 Mar;105(Pt 1):189–213. doi: 10.1093/brain/105.1.189. [DOI] [PubMed] [Google Scholar]
  27. Sundaresan N., Galicich J. H., Bains M. S., Martini N., Beattie E. J., Jr Vertebral body resection in the treatment of cancer involving the spine. Cancer. 1984 Mar 15;53(6):1393–1396. doi: 10.1002/1097-0142(19840315)53:6<1393::aid-cncr2820530629>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  28. Sørensen S., Børgesen S. E., Rohde K., Rasmusson B., Bach F., Bøge-Rasmussen T., Stjernholm P., Larsen B. H., Agerlin N., Gjerris F. Metastatic epidural spinal cord compression. Results of treatment and survival. Cancer. 1990 Apr 1;65(7):1502–1508. doi: 10.1002/1097-0142(19900401)65:7<1502::aid-cncr2820650709>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  29. Viadana E., Bross I. D., Pickren J. W. An autopsy study of some routes of dissemination of cancer of the breast. Br J Cancer. 1973 Apr;27(4):336–340. doi: 10.1038/bjc.1973.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Yap H. Y., Yap B. S., Tashima C. K., DiStefano A., Blumenschein G. R. Meningeal carcinomatosis in breast cancer. Cancer. 1978 Jul;42(1):283–286. doi: 10.1002/1097-0142(197807)42:1<283::aid-cncr2820420142>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  31. Young R. F., Post E. M., King G. A. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980 Dec;53(6):741–748. doi: 10.3171/jns.1980.53.6.0741. [DOI] [PubMed] [Google Scholar]
  32. van der Sande J. J., Kröger R., Boogerd W. Multiple spinal epidural metastases; an unexpectedly frequent finding. J Neurol Neurosurg Psychiatry. 1990 Nov;53(11):1001–1003. doi: 10.1136/jnnp.53.11.1001. [DOI] [PMC free article] [PubMed] [Google Scholar]

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