Zhang Xiaoran, Giantini Larsen Alexandra, Kharas Natasha, Bilsky Mark H, Newman William Christopher
Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Neurosurgery, Weill Cornell Medical Center, New York, New York, USA.
Neurooncol Adv. 2024 Feb 13;6(Suppl 3):iii94-iii100. doi: 10.1093/noajnl/vdae017. eCollection 2024 Oct.
Metastatic epidural spinal cord compression (MESCC) is an increasingly common clinical entity in cancer patients and is associated with significant morbidity and neurologic sequalae. Management of MESCC has undergone many significant paradigms shifts over the past 50 years and was at times managed exclusively with either surgery or radiation. Historically, aggressive surgical techniques to achieve en bloc or intralesional gross tumor resections were pursued but were associated with significant morbidity and poor tumor control rates when combined with conventional external beam radiation. However, improvements in radiation treatment delivery in the form of stereotactic body radiation therapy have allowed for the safe delivery of high-dose conformal photon beam radiation providing histology-independent ablative responses. This shifted the goals of surgery away from maximal tumor resection toward simple spinal cord decompression with reconstitution of the thecal to create a tumor target volume capable of being irradiated within the constraints of spinal cord tolerance. This new approach of creating space between the thecal sac and the tumor was termed separation surgery and when combined with postoperative SBRT, it is referred to as hybrid therapy. Herein, we will describe the evolution of the management of MESCC, the technique of separation surgery and its outcomes, and finish with an illustrative case example.
转移性硬膜外脊髓压迫症（MESCC）在癌症患者中是一种日益常见的临床病症，与显著的发病率和神经后遗症相关。在过去50年里，MESCC的治疗经历了许多重大的模式转变，有时仅通过手术或放疗进行管理。从历史上看，曾采用积极的手术技术以实现整块或瘤内大块肿瘤切除，但与传统外照射放疗联合使用时，会出现显著的发病率且肿瘤控制率不佳。然而，立体定向体部放射治疗形式的放射治疗技术改进，使得高剂量适形光子束辐射能够安全实施，提供不依赖组织学的消融反应。这将手术目标从最大程度的肿瘤切除转向简单的脊髓减压并重建硬膜，以创建一个能够在脊髓耐受范围内进行照射的肿瘤靶体积。这种在硬膜囊和肿瘤之间创造空间的新方法被称为分离手术，当与术后立体定向体部放射治疗联合使用时，被称为混合疗法。在此，我们将描述MESCC治疗的演变、分离手术技术及其结果，并以一个病例示例作为结束。
