Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany.
Nat Rev Clin Oncol. 2010 Oct;7(10):590-8. doi: 10.1038/nrclinonc.2010.137. Epub 2010 Aug 31.
Radiotherapy alone is the most common treatment for metastatic epidural spinal cord compression (MESCC). Decompressive surgery followed by radiotherapy is generally indicated only in 10-15% of MESCC cases. Chemotherapy has an unclear role and may be considered for selected patients with hematological or germ-cell malignancies. If radiotherapy alone is given, it is important to select the appropriate regimen. Similar functional outcomes can be achieved with short-course radiotherapy regimens and longer-course radiotherapy regimens. Longer-course radiotherapy is associated with better local control of MESCC than short-course radiotherapy. Patients with a more favorable survival prognosis (expected survival of ≥6 months) should receive longer-course radiotherapy, as they may live long enough to develop a recurrence of MESCC. Patients with an expected survival of <6 months should be considered for short-course radiotherapy. A recurrence of MESCC in the previously irradiated region after short-course radiotherapy may be treated with another short-course of radiotherapy. After primary administration of longer-course radiotherapy, decompressive surgery should be performed if indicated. Alternatively, re-irradiation can be performed using high-precision techniques to reduce the cumulative dose received by the spinal cord. Larger prospective trials are required to better define the appropriate treatment for the individual patient.
单纯放疗是治疗转移性硬膜外脊髓压迫症（MESCC）最常用的方法。减压手术加放疗通常仅适用于 10-15%的 MESCC 病例。化疗的作用尚不清楚，对于某些血液系统或生殖细胞恶性肿瘤的患者可能需要考虑化疗。如果仅给予放疗，选择合适的方案很重要。短程放疗方案和长程放疗方案均可达到相似的功能结果。与短程放疗相比，长程放疗可更好地控制 MESCC 的局部进展。预计生存时间≥6 个月的患者应接受长程放疗，因为他们可能有足够的生存时间来发展 MESCC 的复发。预计生存时间<6 个月的患者应考虑进行短程放疗。短程放疗后在先前照射区域出现 MESCC 复发，可再次进行短程放疗。在初次给予长程放疗后，如果有指征，应进行减压手术。或者，可以使用高精度技术进行再放疗，以降低脊髓接受的累积剂量。需要更大规模的前瞻性试验来更好地确定每位患者的适当治疗方法。
