Combined therapy for metastatic extradural tumors of the spine.

The effectiveness of combined modality therapy was studied in 29 patients with metastatic extradural spinal tumor who had had a previous diagnosis of malignancy. Dexamethasone was begun upon suspicion of the diagnosis in a dose of 40 mg daily. Following emergency myelography, in all patients without rapid progression, dexamethasone in combination with radiotherapy and chemotherapy, when appropriate, was instituted. If deterioration occurred, decompressive laminectomy was performed. Five ambulatory patients had neurological function preserved and the condition of seven nonambulatory patients was improved to ambulation at discharge with a combination of dexamethasone, radiation therapy, and chemotherapy. These were patients with prostatic carcinoma, Hodgkin's disease, or breast carcinoma. In five patients who failed medical therapy decompressive laminectomy was successful. In patients with metastatic bronchogenic carcinoma, nonsurgical therapy failed and all underwent surgical decompression with a favorable outcome in only two of 10 patients.