A non-randomized prospective trial in which
radiotherapy (RT) alone played the major role in the treatment of metastatic
spinal cord compression (MSCC) is reported. Diagnosis was formulated on myelography and/or myelography plus computed thomography (CT). Of 51 cases treated, 48 are evaluable. The
therapy consisted of radiation alone (42 cases) or decompressive
laminectomy followed by
radiotherapy (6 cases). Surgery was performed when the site of the primary
tumor was unknown. The group of patients who received
radiotherapy alone (42 of 48 evaluable cases) are analysed in this report. Medium to high doses of
steroids were administered to all patients depending on the gravity of the case. Patients with chemo- or
hormone-responsive primary
tumors also received
chemotherapy and/or
hormone therapy.
Pain relief, assessed by comparing use of
narcotics and minor
analgesics before and
after treatment, was achieved in 54% cases (confidence limits, CL = 38-69%). In 36% (CL = 22-51%) of patients
back pain diminished to the point when only milder
analgesics were necessary (partial remission). Motor performance, based on patients' ability to walk, improved in 48% cases (CL = 31-65%). The 19 patients who were ambulatory before RT, did not deteriorate
after treatment. Sphincter function, evaluated by patient's need for
indwelling catheter, improved in 3 of 7 automatic dysfunction cases. It was found that early diagnosis was more important than primary
tumor type for predicting a good was found that early diagnosis was more important than primary
tumor type for predicting a good prognosis. In fact, all ambulating patients responded to treatment independent of the radiosensitivity of the
tumor histology.(ABSTRACT TRUNCATED AT 250 WORDS)