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A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression.

https://arctichealth.org/en/permalink/ahliterature126132
Source
Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):312-7
Publication Type
Article
Date
Oct-1-2012
Author
D Andrew Loblaw
Gunita Mitera
Michael Ford
Normand J Laperriere
Author Affiliation
Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada. andrew.loblaw@sunnybrook.ca
Source
Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):312-7
Date
Oct-1-2012
Language
English
Publication Type
Article
Keywords
Adult
Decompression, Surgical - methods
Dose Fractionation
Humans
Meta-Analysis as Topic
Multicenter Studies as Topic
Neoplasm Recurrence, Local - radiotherapy
Ontario
Randomized Controlled Trials as Topic
Retrospective Studies
Spinal Cord Compression - diagnosis - therapy
Spinal Cord Neoplasms - secondary - therapy
Steroids - therapeutic use
Walking
Abstract
To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC).
A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies.
An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes.
If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur.
PubMed ID
22420969 View in PubMed
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