Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy;
University of Paris School of Medicine, Paris, France.
Anticancer Res. 2022 Apr;42(4):1661-1669. doi: 10.21873/anticanres.15643.
BACKGROUND/AIM: Intradural cauda equina metastases (ICEM) are rare tumors that reduce functional status. Surgery and radiation are feasible and effective treatments but may have debilitating complications. We systematically reviewed the literature on ICEMs.
PubMed, Scopus, Web of Science, and Cochrane were searched for studies reporting clinical data of patients with ICEMs. Clinical characteristics, management strategies, and treatment outcomes were analyzed.
We included 40 studies comprising 123 patients. Median age was 57 years. The most frequent primary tumors were lung (18.7%), breast (13%), and renal carcinomas (11.4%). Median time from primary tumor diagnosis to ICEMs' presentation was 36 months. The most common presenting symptoms were lower back pain (74%) and motor deficits (62.6%), with acute cauda equina syndrome documented in 36 patients (29.3%). Most lesions were diagnosed at magnetic resonance imaging (56.9%) or computed tomography myelography (32.5%). All cases were treated with decompressive laminectomy and tumor resection, with partial resection (82.1%) more often than complete (15.4%). Adjuvant radiotherapy (83.7%) and/or chemotherapy (10.6%) were often administered. Most patients experienced post-treatment symptom improvement (86.2%) and favorable radiological response (82.9%). ICEM recurrences were reported in 4 cases (8.5%) with median local tumor control of 7 months. At last follow-up, most patients were dead (62.9%) with median overall-survival of 10 months.
Patients with ICEMs have poor prognoses and significant tumor burden. Surgery and locoregional radiotherapy may offer optimal clinical and radiological outcomes but have a limited role in improving local tumor control and overall survival.
背景/目的：硬脊膜内马尾转移瘤（ICEM）是一种罕见的肿瘤，会降低功能状态。手术和放疗是可行且有效的治疗方法，但可能会产生使人虚弱的并发症。我们系统地回顾了关于 ICEM 的文献。
在 PubMed、Scopus、Web of Science 和 Cochrane 中搜索了报告 ICEM 患者临床数据的研究。分析了临床特征、管理策略和治疗结果。
我们纳入了 40 项研究，共包括 123 名患者。中位年龄为 57 岁。最常见的原发性肿瘤是肺癌（18.7%）、乳腺癌（13%）和肾细胞癌（11.4%）。从原发性肿瘤诊断到 ICEM 出现的中位时间为 36 个月。最常见的首发症状是腰痛（74%）和运动功能障碍（62.6%），36 例（29.3%）患者出现急性马尾综合征。大多数病变在磁共振成像（56.9%）或计算机断层脊髓造影（32.5%）中诊断。所有病例均行减压椎板切除术和肿瘤切除术，部分切除术（82.1%）多于完全切除术（15.4%）。常采用辅助放疗（83.7%）和/或化疗（10.6%）。大多数患者治疗后症状改善（86.2%），影像学反应良好（82.9%）。4 例（8.5%）报告 ICEM 复发，局部肿瘤控制中位时间为 7 个月。末次随访时，大多数患者死亡（62.9%），总生存中位数为 10 个月。
ICEM 患者预后差，肿瘤负荷大。手术和局部放疗可能提供最佳的临床和影像学结果，但对改善局部肿瘤控制和总生存的作用有限。
