Chapter

Decompressive Surgery for Malignant Spinal Cord Compression

Esmé Finlay and Diaa Osman

in 50 Studies Every Palliative Care Doctor Should Know

Published on behalf of Oxford University Press

Published in print April 2018 | ISBN: 9780190658618
Published online April 2018 | e-ISBN: 9780190658649 | DOI: https://dx.doi.org/10.1093/med/9780190658618.003.0013

Series: Fifty Studies Every Doctor Should Know

Decompressive Surgery for Malignant Spinal Cord Compression

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Metastatic epidural spinal cord compression (MESCC) is a potentially disabling complication associated with advanced cancer. To address whether decompressive surgery followed by radiation therapy is superior to radiation therapy alone, this multi-institutional randomized trial compared outcomes among 101 patients with MESCCC. The study assessed functional outcomes such as ability to ambulate posttreatment, length of ambulation and maintained continence posttreatment, survival time after intervention, and additional functional, quality of life, and medication use outcomes. The practice-changing results of this study indicate that patients who received decompressive surgery and radiation had a longer length of posttreatment ambulation (122 days vs. 13 days, P = 0.03), better overall survival (126 days vs. 100 days, Relative risk 0.60, P = 0.033), lower doses of palliative medications, as well as better performance on several other secondary outcomes. From this landmark study, in appropriately selected patients with MESCC, surgery followed by radiation has become the standard of care.

Chapter.  1308 words.  Illustrated.

Subjects: Palliative Medicine ; Primary Care

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