Role of Decompressive Surgery in Neurologically Intact Patients with Low to Intermediate Intraspinal Metastatic Tumor Burden
Surgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data...
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| Veröffentlicht in: | Cancers 2023-01, Vol.15 (2), p.385 |
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| creator | von Spreckelsen, Niklas Ossmann, Julian Lenz, Maximilian Nadjiri, Lukas Lenschow, Moritz Telentschak, Sergej Meyer, Johanna Keßling, Julia Knöll, Peter Eysel, Peer Goldbrunner, Roland Perrech, Moritz Scheyerer, Max Celik, Eren Zarghooni, Kourosh Neuschmelting, Volker |
| description | Surgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data on whether SD is beneficial are scarce. This study aims to investigate the neurological outcome of patients without neurological deficit, with a low- to intermediate-ESCC, who were treated with or without SD.
This single-center, multidepartment retrospective analysis includes patients treated for spinal epidural metastases from 2011 to 2021. Neurological status was assessed by Frankel grade, and intraspinal tumor burden was categorized according to the ESCC scale. Spinal instrumentation surgery was only considered as SD if targeted decompression was performed.
ESCC scale was determined in 519 patients. Of these, 190 (36.6%) presented with no neurological deficit and a low- to intermediate-grade ESCC (1b, 1c, or 2). Of these, 147 (77.4% were treated with decompression and 43 (22.65%) without. At last follow-up, there was no difference in neurological outcome between the two groups.
Indication for decompressive surgery in neurologically intact patients with low-grade ESCC needs to be set cautiously. So far, it is unclear which patients benefit from additional decompressive surgery, warranting further prospective, randomized trials for this significant cohort of patients. |
| doi_str_mv | 10.3390/cancers15020385 |
| format | Article |
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This single-center, multidepartment retrospective analysis includes patients treated for spinal epidural metastases from 2011 to 2021. Neurological status was assessed by Frankel grade, and intraspinal tumor burden was categorized according to the ESCC scale. Spinal instrumentation surgery was only considered as SD if targeted decompression was performed.
ESCC scale was determined in 519 patients. Of these, 190 (36.6%) presented with no neurological deficit and a low- to intermediate-grade ESCC (1b, 1c, or 2). Of these, 147 (77.4% were treated with decompression and 43 (22.65%) without. At last follow-up, there was no difference in neurological outcome between the two groups.
Indication for decompressive surgery in neurologically intact patients with low-grade ESCC needs to be set cautiously. So far, it is unclear which patients benefit from additional decompressive surgery, warranting further prospective, randomized trials for this significant cohort of patients.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers15020385</identifier><identifier>PMID: 36672334</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Cancer ; Cardiovascular disease ; Chronic obstructive pulmonary disease ; Clinical trials ; Compression ; Decompression ; Diabetes ; Magnetic resonance imaging ; Medical prognosis ; Medical treatment ; Metastases ; Metastasis ; Palliative care ; Patients ; Pre-existing conditions ; Radiation therapy ; Spinal cord ; Statistical analysis ; Surgeons ; Surgery ; Surgical outcomes ; Thrombosis ; Tumors</subject><ispartof>Cancers, 2023-01, Vol.15 (2), p.385</ispartof><rights>2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 by the authors. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c375t-841e94d1e451c21a30834201b2573c7bc75a68ad387e2c3ccfd3453877c68eca3</cites><orcidid>0000-0002-9873-1711 ; 0000-0003-0788-4681</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857075/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857075/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36672334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>von Spreckelsen, Niklas</creatorcontrib><creatorcontrib>Ossmann, Julian</creatorcontrib><creatorcontrib>Lenz, Maximilian</creatorcontrib><creatorcontrib>Nadjiri, Lukas</creatorcontrib><creatorcontrib>Lenschow, Moritz</creatorcontrib><creatorcontrib>Telentschak, Sergej</creatorcontrib><creatorcontrib>Meyer, Johanna</creatorcontrib><creatorcontrib>Keßling, Julia</creatorcontrib><creatorcontrib>Knöll, Peter</creatorcontrib><creatorcontrib>Eysel, Peer</creatorcontrib><creatorcontrib>Goldbrunner, Roland</creatorcontrib><creatorcontrib>Perrech, Moritz</creatorcontrib><creatorcontrib>Scheyerer, Max</creatorcontrib><creatorcontrib>Celik, Eren</creatorcontrib><creatorcontrib>Zarghooni, Kourosh</creatorcontrib><creatorcontrib>Neuschmelting, Volker</creatorcontrib><title>Role of Decompressive Surgery in Neurologically Intact Patients with Low to Intermediate Intraspinal Metastatic Tumor Burden</title><title>Cancers</title><addtitle>Cancers (Basel)</addtitle><description>Surgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data on whether SD is beneficial are scarce. This study aims to investigate the neurological outcome of patients without neurological deficit, with a low- to intermediate-ESCC, who were treated with or without SD.
This single-center, multidepartment retrospective analysis includes patients treated for spinal epidural metastases from 2011 to 2021. Neurological status was assessed by Frankel grade, and intraspinal tumor burden was categorized according to the ESCC scale. Spinal instrumentation surgery was only considered as SD if targeted decompression was performed.
ESCC scale was determined in 519 patients. Of these, 190 (36.6%) presented with no neurological deficit and a low- to intermediate-grade ESCC (1b, 1c, or 2). Of these, 147 (77.4% were treated with decompression and 43 (22.65%) without. At last follow-up, there was no difference in neurological outcome between the two groups.
Indication for decompressive surgery in neurologically intact patients with low-grade ESCC needs to be set cautiously. So far, it is unclear which patients benefit from additional decompressive surgery, warranting further prospective, randomized trials for this significant cohort of patients.</description><subject>Cancer</subject><subject>Cardiovascular disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical trials</subject><subject>Compression</subject><subject>Decompression</subject><subject>Diabetes</subject><subject>Magnetic resonance imaging</subject><subject>Medical prognosis</subject><subject>Medical treatment</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Palliative care</subject><subject>Patients</subject><subject>Pre-existing conditions</subject><subject>Radiation therapy</subject><subject>Spinal cord</subject><subject>Statistical analysis</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical 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(Basel)</addtitle><date>2023-01-06</date><risdate>2023</risdate><volume>15</volume><issue>2</issue><spage>385</spage><pages>385-</pages><issn>2072-6694</issn><eissn>2072-6694</eissn><abstract>Surgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data on whether SD is beneficial are scarce. This study aims to investigate the neurological outcome of patients without neurological deficit, with a low- to intermediate-ESCC, who were treated with or without SD.
This single-center, multidepartment retrospective analysis includes patients treated for spinal epidural metastases from 2011 to 2021. Neurological status was assessed by Frankel grade, and intraspinal tumor burden was categorized according to the ESCC scale. Spinal instrumentation surgery was only considered as SD if targeted decompression was performed.
ESCC scale was determined in 519 patients. Of these, 190 (36.6%) presented with no neurological deficit and a low- to intermediate-grade ESCC (1b, 1c, or 2). Of these, 147 (77.4% were treated with decompression and 43 (22.65%) without. At last follow-up, there was no difference in neurological outcome between the two groups.
Indication for decompressive surgery in neurologically intact patients with low-grade ESCC needs to be set cautiously. So far, it is unclear which patients benefit from additional decompressive surgery, warranting further prospective, randomized trials for this significant cohort of patients.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>36672334</pmid><doi>10.3390/cancers15020385</doi><orcidid>https://orcid.org/0000-0002-9873-1711</orcidid><orcidid>https://orcid.org/0000-0003-0788-4681</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Cancer Cardiovascular disease Chronic obstructive pulmonary disease Clinical trials Compression Decompression Diabetes Magnetic resonance imaging Medical prognosis Medical treatment Metastases Metastasis Palliative care Patients Pre-existing conditions Radiation therapy Spinal cord Statistical analysis Surgeons Surgery Surgical outcomes Thrombosis Tumors |
| title | Role of Decompressive Surgery in Neurologically Intact Patients with Low to Intermediate Intraspinal Metastatic Tumor Burden |
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