Dr Sarah Hargreaves Consultant Clinical Oncologist Malignant Spinal Cord Compression Spinal Cord Compression Pathway at UHBW Clinical or radiological concern about spinal cord compression Contact on call oncology ID: 1014278
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1. Spinal Cord Compression PathwayDr Sarah HargreavesConsultant Clinical Oncologist
2. Malignant Spinal Cord Compression
3. Spinal Cord Compression Pathway at UHBWClinical or radiological concern about spinal cord compression?Contact on call oncology SpRBleep 2490 Out of hours: via switch
4. Radiological suspicion of cord compromise16mg Dexamethasone PO/IV STAT
5. DEMOGRAPHICSOver 4000 patients a year in the UKMetastatic disease5% PatientsFrequently vague presenting symptoms30% will live for over 1 year - QOLTumour type determines time to progression, ambulation at presentation and response to therapy
6. SYMPTOMS/SIGNSBack pain - 95%Weakness – 75%Marked, symmetricalUpper motor neurone deficit = Brisk ankle and knee flexes, up going plantarsAutonomic disturbance – 50%Loss of sphincter function is late Sensory disturbance – 50%Symmetrical
7. ManagementRadiotherapy – Majority of patientsNeurosurgery?FragmentsPS 0-2 Stable disease Life expectancy over 3 monthsNo diagnosisRadioresistant diseaseChemotherapy? HD, NHL, GERM CELL
8. RadiotherapyRandomised to single 8Gy/1F versus 20Gy/5FPEP = ambulatory status at 8 weeks694 patients (255 died before 8 weeks)8Gy/1F did not meet non inferiority criterion for being ambulatory at 8 weeks (69.3% vs 72.7%)Could be considered for patients with LE less than 6 months/poor PS
9. RadiotherapyPrognostic factors may influence the need for treatment, type of treatment and treatment schedule. Potential prognostic factors that might help to determine a positive functional outcome after treatment include: Performance status (ECOG PS 0-2)More favourable histology (lymphoma, myeloma, seminoma, breast, prostate and gastrointestinal)Still ambulatoryMore than two years since original diagnosisSlow development of motor deficit
10. Radiotherapy: OutcomesRetrospective study of 1852 patients8% recurred in field39% improved neurology47% no progression of neurology
11. Side effects related to site
12. Holistic Care
13. Steroid management
14. Remember Cauda EquinaLower motor neurone signs:Flaccid paralysisReduced reflexesUrinary retentionSaddle paraesthesia
15. Spinal Cord Compression Pathway at UHBWClinical or radiological concern about spinal cord compression?Contact on call oncology SpRBleep 2490 Out of hours: via switch
16. The EndThank you, any questions?