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. 1993 Nov;68(5):969–973. doi: 10.1038/bjc.1993.463

Spinal cord compression in breast cancer: a review of 70 cases.

M E Hill 1, M A Richards 1, W M Gregory 1, P Smith 1, R D Rubens 1
PMCID: PMC1968743  PMID: 8217611

Abstract

Spinal cord compression (SCC) is a relatively uncommon but frequently disabling complication of metastatic breast cancer. We have conducted this retrospective study of 70 patients with SCC secondary to breast cancer with the aims of determining risk factors for its development and predictors of outcome. Median age at diagnosis of breast cancer was 51 years with median time to SCC 42 months. All patients had radiological evidence of bone metastases at the time of SCC, and only five were not known to have bone metastases prior to SCC. The most frequent symptom of SCC was motor weakness (96%) followed by pain (94%), sensory disturbance (79%) and sphincter disturbance (61%). Ninety-one percent of patients had at least one symptom for more than a week. Radiotherapy (RT) was given as primary treatment in 43 cases, whilst 21 had decompressive surgery and seven of these went onto have postoperative radiotherapy. Six patients were deemed too unwell for either modality. Following treatment, 96% of those who were ambulant before therapy maintained the ability to walk. In those unable to walk, 45% regained ambulation, with RT and surgery being equally effective. Median survival following SCC was 4 months, with no significant difference between those treated by RT or surgery. The most important predictor of survival was ability to walk after treatment, followed by time from diagnosis of breast cancer to SCC. We conclude that the majority of patients have warning symptoms of SCC and that nearly all will have evidence of spinal bone metastases before compression occurs. The results suggest that earlier diagnosis and intervention could improve outcome. There was no evidence of benefit from surgery over radiotherapy as primary treatment, survival in both treatment groups being poor.

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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. Byrne T. N. Spinal cord compression from epidural metastases. N Engl J Med. 1992 Aug 27;327(9):614–619. doi: 10.1056/NEJM199208273270907. [DOI] [PubMed] [Google Scholar]
  3. Coleman R. E., Rubens R. D. The clinical course of bone metastases from breast cancer. Br J Cancer. 1987 Jan;55(1):61–66. doi: 10.1038/bjc.1987.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. 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]
  5. Delattre J. Y., Arbit E., Thaler H. T., Rosenblum M. K., Posner J. B. A dose-response study of dexamethasone in a model of spinal cord compression caused by epidural tumor. J Neurosurg. 1989 Jun;70(6):920–925. doi: 10.3171/jns.1989.70.6.0920. [DOI] [PubMed] [Google Scholar]
  6. Findlay G. F. Adverse effects of the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry. 1984 Aug;47(8):761–768. doi: 10.1136/jnnp.47.8.761. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. 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]
  8. Goldman J. M., Ash C. M., Souhami R. L., Geddes D. M., Harper P. G., Spiro S. G., Tobias J. S. Spinal cord compression in small cell lung cancer: a retrospective study of 610 patients. Br J Cancer. 1989 Apr;59(4):591–593. doi: 10.1038/bjc.1989.119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. 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]
  10. 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]
  11. Klein S. L., Sanford R. A., Muhlbauer M. S. Pediatric spinal epidural metastases. J Neurosurg. 1991 Jan;74(1):70–75. doi: 10.3171/jns.1991.74.1.0070. [DOI] [PubMed] [Google Scholar]
  12. Lewis D. W., Packer R. J., Raney B., Rak I. W., Belasco J., Lange B. Incidence, presentation, and outcome of spinal cord disease in children with systemic cancer. Pediatrics. 1986 Sep;78(3):438–443. [PubMed] [Google Scholar]
  13. Posner J. B. Back pain and epidural spinal cord compression. Med Clin North Am. 1987 Mar;71(2):185–205. doi: 10.1016/s0025-7125(16)30865-3. [DOI] [PubMed] [Google Scholar]
  14. Richards M. A., Braysher S., Gregory W. M., Rubens R. D. Advanced breast cancer: use of resources and cost implications. Br J Cancer. 1993 Apr;67(4):856–860. doi: 10.1038/bjc.1993.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Salem M. R., Baraka A., Rattenborg C. C., Holaday D. A. Treatment of hiccups by pharyngeal stimulation in anesthetized and conscious subjects. JAMA. 1967 Oct 2;202(1):126–130. doi: 10.1001/jama.202.1.126. [DOI] [PubMed] [Google Scholar]
  16. Siegal T., Siegal T. Current considerations in the management of neoplastic spinal cord compression. Spine (Phila Pa 1976) 1989 Feb;14(2):223–228. doi: 10.1097/00007632-198902000-00015. [DOI] [PubMed] [Google Scholar]
  17. 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]
  18. Ushio Y., Posner R., Kim J. H., Shapiro W. R., Posner J. B. Treatment of experimental spinal cord compression caused by extradural neoplasms. J Neurosurg. 1977 Sep;47(3):380–390. doi: 10.3171/jns.1977.47.3.0380. [DOI] [PubMed] [Google Scholar]
  19. White W. A., Patterson R. H., Jr, Bergland R. M. Role of surgery in the treatment of spinal cord compression by metastatic neoplasm. Cancer. 1971 Mar;27(3):558–561. doi: 10.1002/1097-0142(197103)27:3<558::aid-cncr2820270307>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. Zelefsky M. J., Scher H. I., Krol G., Portenoy R. K., Leibel S. A., Fuks Z. Y. Spinal epidural tumor in patients with prostate cancer. Clinical and radiographic predictors of response to radiation therapy. Cancer. 1992 Nov 1;70(9):2319–2325. doi: 10.1002/1097-0142(19921101)70:9<2319::aid-cncr2820700918>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]

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