Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan.
Cardiovasc Intervent Radiol. 2021 Dec;44(12):1945-1953. doi: 10.1007/s00270-021-02930-1. Epub 2021 Aug 2.
To evaluate the efficacy of chemoembolization for inoperable metastatic epidural spinal cord compression (MESCC) refractory to re-radiotherapy.
Nineteen consecutive patients with recurrent MESCC after re-radiotherapy who had undergone chemoembolization were retrospectively analyzed. Outcome measures were pain relief rate, neurological improvement rate, objective response rate, and adverse events. MESCC degree classification was assessed using Bilsky grades. Pain assessment was performed using Numerical Rating Scale, and neurological function was evaluated using the Frankel classification.
The median follow-up period was 7 (range 2-44) months. All participants had MESCC grade 2 or higher and had severe pain. Fifteen patients (79%) had neurological deficits, and ten had Frankel classification C and five had D. Symptoms were relieved in almost all patients the day following chemoembolization. Pain relief was achieved in 18 of 19 (95%) patients; the median decrease in Numerical Rating Scale score was 8 (range 0-10; p < 0.001). Neurological improvement was achieved in 11 of 15 patients (73%); the median increase in Frankel classification was 1 (range 0-2; p = 0.006). Ten of 19 (53%) patients showed a reduction in MESCC; the median decrease in Bilsky grade was 1 (range 0-2; p = 0.005). There was no correlation between the change in Bilsky grade and pain relief (p = 0.421). However, the decrease in Bilsky grade significantly improved neurological symptoms (p = 0.01). No serious adverse events occurred.
Chemoembolization may be a useful palliative treatment modality for MESCC refractory to re-radiotherapy.
Level 3b, Follow up Study.
评估化疗栓塞术治疗复发性放疗后不可手术的转移性硬膜外脊髓压迫症（MESCC）的疗效。
回顾性分析了 19 例复发性放疗后接受化疗栓塞术的不可手术的转移性硬膜外脊髓压迫症患者。观察指标包括疼痛缓解率、神经改善率、客观缓解率和不良事件。MESCC 程度分级采用 Bilsky 分级。疼痛评估采用数字评分法，神经功能评估采用 Frankel 分级。
中位随访时间为 7 个月（范围 2-44 个月）。所有患者均为 MESCC 2 级或以上，且疼痛剧烈。15 例（79%）患者存在神经功能障碍，10 例患者为 Frankel 分级 C，5 例为 D。化疗栓塞术后几乎所有患者的症状均在当天得到缓解。19 例患者中有 18 例（95%）疼痛缓解，数字评分法评分中位数下降 8 分（范围 0-10；p<0.001）。15 例患者中有 11 例（73%）神经功能改善，Frankel 分级中位数升高 1 级（范围 0-2；p=0.006）。19 例患者中有 10 例（53%）MESCC 减轻，Bilsky 分级中位数下降 1 级（范围 0-2；p=0.005）。Bilsky 分级的变化与疼痛缓解无相关性（p=0.421）。然而，Bilsky 分级的下降显著改善了神经症状（p=0.01）。未发生严重不良事件。
化疗栓塞术可能是一种治疗复发性放疗后不可手术的转移性硬膜外脊髓压迫症的有效姑息治疗方法。
3b 级，随访研究。
