| Objective:Intramedullary spinal cord metastases(ISCM)in malignancies is a devastating issue with limited research.This study aims to identify the clinical features,management,prognostic factors and outcomes of this special entity.Methods:A retrospective review of 61 patients of ISCM diagnosed and treated in our institute from June,2010 to March,2018 were conducted(lost of follow-up: 3).Data were retrieved according to the items including age,gender,primary tumor,interval to the ISCM occurrence,ISCM segments,other synchronous metastases.The interventions,response,prognostic factors and outcomes of ISCM were systematically analyzed.Results:Lung cancer(67.21%)was the commonest ISCM source followed by breast cancer(14.75%).9.84% patients presented with ISCM initially.The median span from the primaries to ISCM was 18.77 months(range,0-10 years).Thoracic segment was most commonly involved(77.05%),followed by cervical(39.34%),lumbar level(34.43%)and conus medullaris(6.56%).The management of ISCM was challenging since 55.74% of individuals had a poor physical condition(PS:3-4)and 72.41% had widespread dissemination synchronously(? 2 organs).Radiotherapy(RT)attained an objective response rate(ORR)of 61.90% or 62.50% and local control rate(LCR)of 90.48% or87.50% for symptoms used alone or with other strategies respectively.ISCM bears a dismal prognosis with a median overall survival(OS)of 4 months.Patients with only 1 segment involved had apparently better prognosis than those with 2-4 involved segments(median OS: 7.0 vs 3.0 months)(P<0.01).The OS of patients treated was remarkably superior to those without any intervention(median OS: 5.0 vs 2.0 months)(P<0.01).Conclusion:ISCM is a special entity needing more attention with increasing incidence and still grim prognosis.Early diagnosis and multidisciplinary approach are critical for a better outcome.RT is the mainstay with satisfactory effect.Multiple spinal cord segments involvement and no treatment are poor prognostic factors of OS. |
PDF Full Text Request