SURGERY FOR SPINAL CORD COMPRESSION DUE TO CANCER

由转移性癌症引起的脊髓压迫排在第二位 癌症常见的神经系统并发症，影响所有癌症的5%-15% 实体瘤患者。通过放射治疗，目前的标准是 治疗后，只有不到一半的患者处于活动状态。 非对照研究表明，直接的 通过手术切除肿瘤进行脊髓减压术 实际造成脐带压迫加上术后放疗可能 比单纯的辐射要好得多。然而，只有不受控制的 已有报道称，非随机研究的明显优势是 在这些初步报告中发现的手术可能完全是由于 预选预后良好的患者。我们建议做一个 多机构前瞻性随机试验确定实际 直接减压手术的价值(如果有的话)。患有癌症的患者 临床和放射学(或MRI)证据将是脐带受压 随机分配到只接受放射治疗(3000cGy)或 直接减压手术后放射治疗(3000cGy.那里 总共将有200名患者(每条手臂各100名)。手术将会是 使用最直接的入路切除肿瘤，而肿瘤 造成脊髓受压的情况将被移除。术中 脊柱稳定(使用金属棒或重建脊柱 椎体有丙烯酸)，如果脊柱不稳 现在时。研究的主要终点将是非卧床费率岗位 治疗，止痛，保留肠道和膀胱功能， 复发率和复发时间。的主要潜在好处 这项研究将确定侵袭性脊柱手术在 转移性硬膜外脊髓压迫的治疗。考虑到穷人 结果单纯放射治疗后，行走速度或疼痛的任何改善 手术带来的缓解将是对 治疗这个相当常见的肿瘤学问题。另一方面，如果 积极的脊柱手术被证明是没有价值的，那么这种做法 应该停产。只有经过仔细对照的随机试验 将决定这一问题。

Spinal cord compression caused by metastatic cancer is the second most common neurologic complication of cancer and affects 5-15% of all cancer patients with solid tumors. With radiation therapy, the current standard treatment, less than half of patients are ambulatory after treatment. Uncontrolled studies have suggested that the combination of direct decompression of the spinal cord by surgical removal of the tumor actually causing the cord compression plus postoperative radiotherapy may be substantially better than radiation alone. However, only uncontrolled nonrandomized studies have been reported, and the apparent advantage of surgery found in these preliminary reports could be entirely due to preselection of good prognosis patients. We propose to do a multi-institutional prospective randomized trial to determine the actual value (if any) of direct decompressive surgery. Cancer patients with clinical and radiographic (or MRI) evidence of cord compression will be randomly assigned to treatment with either radiation alone (3,000 cGy) or direct decompressive surgery followed by radiotherapy (3,000 cGy). There will be a total of 200 patients (100 in each arm). The surgery will be performed using the most direct approach to the tumor, and the tumor causing the spinal cord compression will be removed. Intraoperative stabilization of the spine (using metallic rods or reconstruction of the vertebral body with acrylic) will be done if spinal instability is present. Major endpoints of the study will be ambulatory rate post treatment, pain relief, preservation of bowel and bladder function, recurrence rate, and time to recurrence. The main potential benefit of this study will be to determine the value of aggressive spinal surgery in the treatment of metastatic epidural cord compression. Given the poor results with radiation alone, any improvement in ambulatory rate or pain relief that results from surgery would be a major advance in the treatment of this fairly common oncologic problem. On the other hand, if aggressive spinal surgery is shown to be of no value, then the practice should be discontinued. Only a carefully controlled randomized trial will decide the issue.