Louisiana State University Health Sciences Center
Correspondence to: Federico L. Ampil, MD, Division of Radiation Oncology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, Louisiana 71130; e-mail: firstname.lastname@example.org
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.2–3
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
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
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,
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
Some patients had more than one segment
The numbers in parentheses indicate the
numbers of evaluable patients.
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