Radiation therapy for spinal epidural metastases with complete block.

Myelography was performed in 535 patients at the Memorial Sloan-Kettering Hospital from January 1979 to December 1979. In 110 cases a complete block was demonstrated and of these, 78 had epidural metastases. A uniform treatment was applied using radiation therapy and high dose steroid. The neurologic outcome for each patient was evaluated, correlating pre-treatment neurologic status, pathologic type, nature of block (level, structural versus tumoral), and result of repeat fluoromyelography. Only 2 patients improved, but 11 became completely paraplegic. The survival was influenced by the ambulatory status after treatment (median survival: 52.7 weeks in the ambulatory group and 4.6 weeks in the paraplegic). Based on this series, rational approach and management of complete block secondary to spinal epidural metastases are discussed.