Barcena A, Lobato R D, Rivas J J, Cordobes F, de Castro S, Cabrera A, Lamas E
Neurosurgery. 1984 Dec;15(6):820-7.
The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spinal metastases to determine the influence of factors such as tumor biology and topography, pretreatment neurological status, the presence of a myelographic block, the progression rate of symptoms, and the general medical condition of the patient on both the functional prognosis and the choice of treatment. Both life expectancy and the functional results after therapy are mainly dependent on tumor biology, which in turn determines radiosensitivity. The remaining factors seem to have only complementary predictive power. Because radiotherapy has been found to be as effective as operation plus radiotherapy in the management of the majority of patients with spinal metastases, it is very important to improve the selection of surgical candidates (less than 42% of the total cases) to prevent unnecessary surgery-related morbidity and mortality. Factors considered important in the selection of therapy are the location of the tumor within the spinal canal, the neurological status at the time of treatment, and the systemic condition of the patient.
作者对31个外科手术和放射治疗系列进行了调查，这些系列包含2300多名脊柱转移瘤患者，以确定肿瘤生物学和部位、治疗前神经状态、脊髓造影阻塞的存在、症状进展速度以及患者的一般医疗状况等因素对功能预后和治疗选择的影响。预期寿命和治疗后的功能结果主要取决于肿瘤生物学，而肿瘤生物学又决定了放射敏感性。其余因素似乎只有互补的预测能力。由于已发现放射治疗在大多数脊柱转移瘤患者的治疗中与手术加放射治疗一样有效，因此改进手术候选者（占总病例的不到42%）的选择以预防不必要的手术相关发病率和死亡率非常重要。在选择治疗方法时被认为重要的因素是肿瘤在椎管内的位置、治疗时的神经状态以及患者的全身状况。
