0
Communications to the Editor |

A Retrospective Study of Metastatic Lung Cancer Compression of the Cauda Equina FREE TO VIEW

Federico L. Ampil, MD; Glenn M. Mills, MD; Gary V. Burton, MD
Author and Funding Information

Louisiana State University Health Sciences Center Shreveport, LA

Correspondence to: Federico L. Ampil, MD, Division of Radiation Oncology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, Louisiana 71130; e-mail: fampil@lsuhsc.edu



Chest. 2001;120(5):1754-1755. doi:10.1378/chest.120.5.1754
Text Size: A A A
Published online

To the Editor:

Spinal cord compression by metastatic tumor is more commonly encountered than is compression of the cauda equina.1Lung cancer reportedly metastasizes more often to the thoracic segments of the spine than to other parts of the vertebral column.23 The paucity of data concerning patients’ outcomes in cases of cauda equina compression by metastatic lung cancer (CEC-MLC) and the pervading interest in outcomes research prompted this retrospective study of patients.

From 1984 to 1997, 2,285 new cases of documented lung cancer were evaluated at two university-affiliated hospitals. From a review of the radiation oncology patient records, 16 cases (0.7%) of CEC-MLC were identified.

The diagnosis of compression of the cauda equina was based on clinical examination and radioimaging findings. Myelography was used more frequently than MRI to demonstrate the metastatic lesion and the thecal/neural sac compression.

CEC-MLC affected men more than women (Table 1 ). Back pain and impaired muscle strength of the lower limbs were the predominant manifestations. The average duration of symptoms and signs of cauda equina compression was 89 days (range, 1 to 270 days). The most common histologic type of bronchogenic carcinoma was non-small cell cancer. The upper lobe of the lungs was affected the most. Ten patients had known metastatic disease elsewhere in the body. The lumbar segments of the cauda equina were mainly affected, rather than the sacral portions.

Treatment consisted of localized radiotherapy using a megavoltage photon beam from a 6-mV linear accelerator. The applied total dose was usually 30 Gy in 10 fractions, administered daily for 5 consecutive days. Corticosteroid medication, administered in a tapering fashion, was initiated as soon as the diagnosis of CEC-MLC was established. The achievement of palliation is shown in Table 2 . The overall average survival was 2 months (range 1 to 13 months). The poor prognosis observed in the present study is in accord with that noted by other investigators.4 Tatsui and colleagues,4 in evaluating survival of patients after the detection of spinal metastases, found that survival was shorter in individuals with lung cancer compared with survival of patients with breast cancer (3.6 ± 6.1 months vs 29.4 ± 33.5 months, respectively).

In conclusion, it must be stated that the condition of CEC-MLC, though rare and associated with a grim prognosis, is amenable to effective palliation (as was determined in our small number of treated patients).

Table Graphic Jump Location
Table 1. Demographic Data
* 

Some patients had more than one segment involved.

Table Graphic Jump Location
Table 2. Subjective and Objective Responses to Radiotherapy*
* 

The numbers in parentheses indicate the numbers of evaluable patients.

References

Wright, RL (1963) Malignant tumors in the spinal extradural space: results of surgical treatment.Ann Surg157,227-231. [PubMed] [CrossRef]
 
Gilbert, RW, Kim, JH, Posner, JB Epidural spinal cord compression from metastatic tumor: diagnosis and treatment.Ann Neurol1978;3,40-51. [PubMed]
 
Sorensen, PS, Borgesen, SE, Rohde, K, et al Metastatic epidural spinal compression: results of treatment and survival.Cancer1990;65,1502-1508. [PubMed]
 
Tatsui, H, Onomura, T, Morishita, S, et al Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation.Spine1996;21,2143-2148. [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1. Demographic Data
* 

Some patients had more than one segment involved.

Table Graphic Jump Location
Table 2. Subjective and Objective Responses to Radiotherapy*
* 

The numbers in parentheses indicate the numbers of evaluable patients.

References

Wright, RL (1963) Malignant tumors in the spinal extradural space: results of surgical treatment.Ann Surg157,227-231. [PubMed] [CrossRef]
 
Gilbert, RW, Kim, JH, Posner, JB Epidural spinal cord compression from metastatic tumor: diagnosis and treatment.Ann Neurol1978;3,40-51. [PubMed]
 
Sorensen, PS, Borgesen, SE, Rohde, K, et al Metastatic epidural spinal compression: results of treatment and survival.Cancer1990;65,1502-1508. [PubMed]
 
Tatsui, H, Onomura, T, Morishita, S, et al Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation.Spine1996;21,2143-2148. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543