Dirk Rades1, Stefan Janssen2, Lukas Käsmann3, Louisa Bolm3, Steven E Schild4. 1. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany rades.dirk@gmx.net. 2. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany. 3. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. 4. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A.
Abstract
AIM: Epidural spinal cord compression (ESCC) from thyroid cancer is uncommon. This study aimed to contribute to the identification of the most appropriate treatment for these patients. PATIENTS AND METHODS: Fourteen patients receiving irradiation alone were retrospectively evaluated. RESULTS: Improvement of motor deficits occurred in 36% of patients, further progression was prevented in another 43% (overall response=79%). One of six non-ambulatory patients (17%) became ambulatory. The 12-month rate of freedom from in-field recurrence was 85%; long-course irradiation was superior to short-course irradiation (100% vs. 67%, p=0.11). The 12-month survival rate was 41%. Age <70 years (p=0.007), no other metastases (p=0.007), differentiated cancer (p<0.001), ability to walk (p=0.015), affection of 1-3 vertebrae (p<0.001) and better performance score (p=0.007) were associated with survival. CONCLUSION: Irradiation resulted in a good response. Neurosurgery appears required for non-ambulatory patients to restore walking ability. Long-course irradiation resulted in excellent long-term freedom from in-field recurrence and appears preferable for patients with favorable survival prognoses. Copyright
AIM: Epidural spinal cord compression (ESCC) from thyroid cancer is uncommon. This study aimed to contribute to the identification of the most appropriate treatment for these patients. PATIENTS AND METHODS: Fourteen patients receiving irradiation alone were retrospectively evaluated. RESULTS: Improvement of motor deficits occurred in 36% of patients, further progression was prevented in another 43% (overall response=79%). One of six non-ambulatory patients (17%) became ambulatory. The 12-month rate of freedom from in-field recurrence was 85%; long-course irradiation was superior to short-course irradiation (100% vs. 67%, p=0.11). The 12-month survival rate was 41%. Age <70 years (p=0.007), no other metastases (p=0.007), differentiated cancer (p<0.001), ability to walk (p=0.015), affection of 1-3 vertebrae (p<0.001) and better performance score (p=0.007) were associated with survival. CONCLUSION: Irradiation resulted in a good response. Neurosurgery appears required for non-ambulatory patients to restore walking ability. Long-course irradiation resulted in excellent long-term freedom from in-field recurrence and appears preferable for patients with favorable survival prognoses. Copyright