Daisuke Tateiwa1, Kazuya Oshima2, Takaaki Nakai3, Yoshinori Imura3, Takaaki Tanaka3, Hidetatsu Outani1, Hironari Tamiya3, Nobuhito Araki4, Norifumi Naka3. 1. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. 2. Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuuou, Osaka 541-8567, Japan. Electronic address: oshimakazuya@gmail.com. 3. Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuuou, Osaka 541-8567, Japan. 4. Department of Orthopaedic Surgery, Ashiya Municipal Hospital, 39-1 Asahigaoka, Ashiya City, Hyogo 659-8502, Japan.
Abstract
BACKGROUND: The development of effective chemotherapy regimens and molecular targeting agents are improving the overall survival rates in patients with cancer. However, patients who are non-ambulatory due to metastatic epidural spinal cord compression (MESCC) may be assessed as unable to tolerate chemotherapy secondary to poor performance status. This means that the ambulatory status of patients with cancer might be significant for survival time. METHODS: We investigated the functional outcomes and factors influencing overall survival in 31 patients who were non-ambulatory due to MESCC and underwent decompression surgery. The functional outcome was determined by the Frankel grading system. RESULT: Twenty-one patients (68%) improved by at least 1 Frankel grade; 17 patients (55%) became ambulatory postoperatively. Most of postoperatively ambulatory patients could undergo postoperative chemotherapy (14/17, 82%). On the other hand, only a few postoperatively non-ambulatory patients could undergo postoperative chemotherapy (2/15, 13%). We observed a complication rate of 35.5% with specific complications including wound infection, pneumonia, and deep vein thrombosis/pulmonary embolus. The median survival duration was 7.0 months. Factors that significantly affected the overall survival in univariate analyses were revised Tokuhashi score (RTS) ≥ 4, postoperative chemotherapy, ambulatory status, and complications (RTS ≥ 4, P < 0.05; postoperative chemotherapy, P < 0.001; ambulatory status, P < 0.001; complications, P < 0.01). CONCLUSIONS: Decompression surgery for patients who are non-ambulatory due to MESCC directly contributes to functional outcomes and may indirectly contribute to overall survival. If non-ambulatory patients who are assessed as unable to tolerate chemotherapy due to poor performance status regain the ability to walk by decompression surgery, they will have a chance to receive postoperative chemotherapy, thereby increasing their chances of prolonging survival. However, postoperative complications may shorten their survival; therefore, we should carefully consider the surgical indications. RTS is useful for judging the surgical indication.
BACKGROUND: The development of effective chemotherapy regimens and molecular targeting agents are improving the overall survival rates in patients with cancer. However, patients who are non-ambulatory due to metastatic epidural spinal cord compression (MESCC) may be assessed as unable to tolerate chemotherapy secondary to poor performance status. This means that the ambulatory status of patients with cancer might be significant for survival time. METHODS: We investigated the functional outcomes and factors influencing overall survival in 31 patients who were non-ambulatory due to MESCC and underwent decompression surgery. The functional outcome was determined by the Frankel grading system. RESULT: Twenty-one patients (68%) improved by at least 1 Frankel grade; 17 patients (55%) became ambulatory postoperatively. Most of postoperatively ambulatory patients could undergo postoperative chemotherapy (14/17, 82%). On the other hand, only a few postoperatively non-ambulatory patients could undergo postoperative chemotherapy (2/15, 13%). We observed a complication rate of 35.5% with specific complications including wound infection, pneumonia, and deep vein thrombosis/pulmonary embolus. The median survival duration was 7.0 months. Factors that significantly affected the overall survival in univariate analyses were revised Tokuhashi score (RTS) ≥ 4, postoperative chemotherapy, ambulatory status, and complications (RTS ≥ 4, P < 0.05; postoperative chemotherapy, P < 0.001; ambulatory status, P < 0.001; complications, P < 0.01). CONCLUSIONS: Decompression surgery for patients who are non-ambulatory due to MESCC directly contributes to functional outcomes and may indirectly contribute to overall survival. If non-ambulatory patients who are assessed as unable to tolerate chemotherapy due to poor performance status regain the ability to walk by decompression surgery, they will have a chance to receive postoperative chemotherapy, thereby increasing their chances of prolonging survival. However, postoperative complications may shorten their survival; therefore, we should carefully consider the surgical indications. RTS is useful for judging the surgical indication.
Authors: F Cofano; G Di Perna; A Alberti; B M Baldassarre; M Ajello; N Marengo; F Tartara; F Zenga; D Garbossa Journal: J Bone Oncol Date: 2020-11-10 Impact factor: 4.072
Authors: Giuseppe Di Perna; Fabio Cofano; Cristina Mantovani; Serena Badellino; Nicola Marengo; Marco Ajello; Ludovico Maria Comite; Giuseppe Palmieri; Fulvio Tartara; Francesco Zenga; Umberto Ricardi; Diego Garbossa Journal: J Bone Oncol Date: 2020-09-26 Impact factor: 4.072
Authors: Moritz Lenschow; Maximilian Lenz; Niklas von Spreckelsen; Julian Ossmann; Johanna Meyer; Julia Keßling; Lukas Nadjiri; Sergej Telentschak; Kourosh Zarghooni; Peter Knöll; Moritz Perrech; Eren Celik; Max Scheyerer; Volker Neuschmelting Journal: Cancers (Basel) Date: 2022-04-27 Impact factor: 6.575