Goldman J M, Ash C M, Souhami R L, Geddes D M, Harper P G, Spiro S G, Tobias J S
Brompton Hospital, London, UK.
Br J Cancer. 1989 Apr;59(4):591-3. doi: 10.1038/bjc.1989.119.
The records of 610 consecutive patients with small cell lung cancer, treated on a common protocol in a multicentre trial, were reviewed and 24 (4%) cases of spinal cord compression identified. Five hundred patients had isotope bone scans performed at presentation, and in 131 (26%) there was abnormal isotope uptake in the spinal column; only 7% of these patients developed spinal cord compression. However, of the 24 patients who presented with back pain and had a positive bone scan affecting the spine, 36% developed cord compression. Cerebral metastases occurred at some stage in 19.5% of all patients and in 45% of patients with cord compression. The combination of cerebral metastases and a positive bone scan gave a 25% chance of developing spinal cord compression. There were two distinct forms of clinical presentation. Six patients (group A) presented with cord compression: All had back pain and positive bone scans, five out of six had sphincter disturbance, and median survival from cord compression was 30 weeks. Eighteen patients (group B) developed cord compression while on treatment: 28% had positive initial bone scans, 44% back pain and 61% sphincter disturbance, and median survival from cord compression was 4 weeks. Spinal cord compression is an important cause of morbidity and mortality in small cell lung cancer. We suggest that it may be possible to select patients who should receive radiotherapy to the spine to try to prevent the development of this complication.
回顾了在一项多中心试验中按照通用方案治疗的610例连续性小细胞肺癌患者的记录，识别出24例（4%）脊髓压迫病例。500例患者在就诊时进行了同位素骨扫描，其中131例（26%）脊柱有同位素摄取异常；这些患者中只有7%发生了脊髓压迫。然而，在24例出现背痛且脊柱骨扫描呈阳性的患者中，36%发生了脊髓压迫。19.5%的所有患者在某个阶段发生了脑转移，而在脊髓压迫患者中这一比例为45%。脑转移和骨扫描阳性同时出现时，发生脊髓压迫的几率为25%。有两种不同的临床表现形式。6例患者（A组）以脊髓压迫为表现：均有背痛且骨扫描阳性，6例中有5例存在括约肌功能障碍，脊髓压迫后的中位生存期为30周。18例患者（B组）在治疗期间发生脊髓压迫：28%初始骨扫描阳性，44%有背痛，61%有括约肌功能障碍，脊髓压迫后的中位生存期为4周。脊髓压迫是小细胞肺癌发病和死亡的重要原因。我们认为，有可能筛选出应该接受脊柱放疗以试图预防这种并发症发生的患者。
