Treatment of Metastatic Spinal Cord Compression: cepo Review and Clinical Recommendations

Background: Metastatic spinal cord compression (MSCC) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l’évolution des pratiques en oncologie (CEPO) made recommendations on MSCC management. Method: A review of the scientific literature published up to February 2011 considered only phase II and III trials that included assessment of neurologic function. A total of 26 studies were identified. Recommendations: Considering the evidence available to date, CEPO recommends that (1) cancer patients with MSCC be treated by a specialized multidisciplinary team. (2) dexamethasone 16 mg daily be administered to symptomatic patients as soon as MSCC is diagnosed or suspected. (3) high-loading-dose corticosteroids be avoided. (4) histopathologic diagnosis and scores from scales evaluating prognosis and spinal instability be considered before treatment. (5) corticosteroids and chemotherapy with radiotherapy be offered to patients with spinal cord compression caused by myeloma, lymphoma, or germ cell tumour without sign of spinal instability or compression by bone fragment. (6) short-course radiotherapy be administered to patients with spinal cord compression and short life expectancy. (7) long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy. (8) decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic MSCC patients (including spinal instability, displacement of vertebral fragment); and (9) patients considered for surgery have a life expectancy of at least 3–6 months.