Boussios Stergios, Cooke Deirdre, Hayward Catherine, Kanellos Foivos S, Tsiouris Alexandros K, Chatziantoniou Aikaterini A, Zakynthinakis-Kyriakou Nikolaos, Karathanasi Afroditi
Acute Oncology Assessment Unit, Medway NHS Foundation Trust, Kent, U.K.
Department of Biological Applications & Technology, University of Ioannina, Ioannina, Greece.
Anticancer Res. 2018 Sep;38(9):4987-4997. doi: 10.21873/anticanres.12817.
Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer. Patients often present with a history of progressive pain, paralysis, sensory loss, progressive spinal deformity, and loss of sphincter control. It is an emergency that requires rapid decision making on the part of several specialists, given the risk of permanent spinal cord injury or death. The goals of treatment in spinal metastases are pain control and improvement of neurological function in order to achieve better quality of life (QoL). The standard of care in most cases is rapid initiation of corticosteroids in combination with either surgical decompression in case of an operable candidate, followed by radiation therapy (RT) or RT alone. Surgery is associated with improved outcomes, but is not appropriate for many patients presenting with advanced symptoms of MSCC, such as paralysis, or those with a poor performance status, or cachexic state, as well as altered mental conditions, co-morbidities, surgical risks, and limited life expectancy. On the other hand, aggressive surgical treatment and post-operative RT is advocated for those with more favorable prognosis, or who are expected to have higher neurological recovery potential. Many candidates may require for combined anterior and posterior approaches to effectively deal with the compressive pathology and stabilize the spine. Most patients are presently treated by primary RT, given with the aim of improving function and symptom management. However, there is still debate regarding the most appropriate RT schedule. Rehabilitation can serve to relieve symptoms, QoL, enhance functional independence, and prevent further complications. Ambulatory status has been found to be an important prognostic factor for patients with MSCC.
恶性脊髓压迫（MSCC）是癌症最具毁灭性的并发症之一。患者通常有进行性疼痛、瘫痪、感觉丧失、进行性脊柱畸形和括约肌控制丧失的病史。鉴于存在永久性脊髓损伤或死亡的风险，这是一种需要多位专家迅速做出决策的紧急情况。脊柱转移瘤的治疗目标是控制疼痛和改善神经功能，以提高生活质量（QoL）。在大多数情况下，标准治疗方法是迅速开始使用皮质类固醇，对于可手术的患者，联合手术减压，随后进行放射治疗（RT）或单独进行RT。手术与更好的预后相关，但不适用于许多出现MSCC晚期症状（如瘫痪）的患者，或那些身体状况差、恶病质状态以及精神状态改变、合并症、手术风险高和预期寿命有限的患者。另一方面，对于预后较好或预计神经恢复潜力较高的患者，提倡积极的手术治疗和术后RT。许多患者可能需要联合前后路手术来有效处理压迫性病变并稳定脊柱。目前大多数患者接受原发性RT治疗，目的是改善功能和症状管理。然而，关于最合适的RT方案仍存在争议。康复可以缓解症状、提高生活质量、增强功能独立性并预防进一步的并发症。已发现步行状态是MSCC患者的一个重要预后因素。
