Department of Radiation Oncology, University of Lubeck, Lubeck, Germany.
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ.
Semin Radiat Oncol. 2023 Apr;33(2):148-158. doi: 10.1016/j.semradonc.2022.11.005.
"True" malignant epidural spinal cord compression (MESCC) is used here to describe a lesion compressing of infiltrating the spinal cord associated with neurologic deficits. Radiotherapy alone is the most common treatment, for which several dose-fractionation regimens are available including single-fraction, short-course and longer-course regimens. Since these regimens are similarly effective regarding functional outcomes, patients with poor survival are optimally treated with short-course or even single-fraction radiotherapy. Longer-course radiotherapy results in better local control of malignant epidural spinal cord compression. Since most in-field recurrences occur 6 months or later, local control is particularly important for longer-term survivors who, therefore, should receive longer-course radiotherapy. It is important to estimate survival prior to treatment, which is facilitated by scoring tools. Radiotherapy should be supplemented by corticosteroids, if safely possible. Bisphosphonates and RANK-ligand inhibitors may improve local control. Selected patients can benefit from upfront decompressive surgery. Identification of these patients is facilitated by prognostic instruments considering degree of compression, myelopathy, radio-sensitivity, spinal stability, post-treatment ambulatory status, and patients' performance status and survival prognoses. Many factors including patients' preferences must be considered when designing personalized treatment regimens.
“真性”恶性硬膜外脊髓压迫症（MESCC）用于描述浸润脊髓并伴有神经功能缺损的病变。单独放疗是最常见的治疗方法，有几种剂量分割方案可供选择，包括单次分割、短程和长程方案。由于这些方案在功能结局方面同样有效，因此对于生存预后较差的患者，最好采用短程甚至单次分割放疗。长程放疗可更好地控制恶性硬膜外脊髓压迫症的局部进展。由于大多数场内复发发生在 6 个月或更晚，因此对于长期生存者，局部控制尤为重要，因此他们应该接受长程放疗。在治疗前评估生存情况很重要，评分工具可以为此提供帮助。如果安全可行，放疗应辅以皮质类固醇。双膦酸盐和 RANK 配体抑制剂可能会改善局部控制。部分患者可从 upfront 减压手术中获益。预后工具可用于识别这些患者，这些工具考虑了压迫程度、脊髓病、放射敏感性、脊柱稳定性、治疗后活动状态以及患者的体能状态和生存预后。在制定个性化治疗方案时，必须考虑许多因素，包括患者的偏好。
