Spinal metastases. A retrospective survey from a general hospital.

One hundred and thirty-one patients presenting to a general hospital with neurological symptoms deriving from spinal metastases were reviewed. The primary site of tumour was the lung in 33 per cent, breast in 28 per cent, other sites in 25 per cent and unknown in 14 per cent. Haematological malignancies were excluded. In 47 per cent of cases the spinal metastasis produced the first evidence of malignant disease. Spinal or radicular pain was the initial complaint in 69 per cent of cases, followed by the appearance of neurological symptoms. Leg weakness usually preceded sphincter disturbance, and was the commonest reason for referral. Spinal cord compression occurred in 106 patients, 10 had compression of conus medullaris or cauda equina and 15 had evidence of radicular compression only. Plain x-rays of the spine were abnormal in 84 per cent of patients, and in 94 per cent of those with carcinoma of the breast. The results of treatment by radiotherapy alone were retrospectively compared with those of surgical decompression (with or without radiotherapy). There was no significant difference between these results for immediate response to treatment or for long-term outcome. The best predictor of outcome was the site of primary tumour. Only 17 per cent of patients with lung cancer responded well to treatment and only 2 per cent were alive one year after treatment; 51 per cent of patients with breast cancer responded well and 36 per cent were alive at one year. Surgical treatment is considered preferable in cases in which the diagnosis of cancer is not proven, when there is a possibility of neural compression by diseased bone rather than soft tumour tissue and when the area has previously been irradiated. These groups accounted for about 60 per cent of our patients. Radiotherapy alone may be preferred if multiple lesions are demonstrated. In other cases a therapeutic decision is required. The availability of neurosurgical and radiotherapeutic facilities will be a factor. There is no clear evidence from our figures or from the literature of a difference between results obtained by radiotherapy alone and those with surgical decompression followed by irradiation. The choice of treatment will depend upon the particular requirements of each individual parent.