Neurological Outcomes and the Need for Retreatments Among Multiple Myeloma Patients With High-Grade Spinal Cord Compression: Radiotherapy vs Surgery

被引:3
作者
Zijlstra, Hester [1 ,2 ,6 ]
Crawford, Alexander M. [1 ]
Striano, Brendan M. [1 ]
Pierik, Robert-Jan [1 ]
Tobert, Daniel G. [1 ]
Wolterbeek, Nienke [3 ]
Delawi, Diyar [3 ]
Terpstra, Wim E. [4 ]
Kempen, Diederik H. R. [5 ]
Verlaan, Jorrit-Jan [2 ]
Schwab, Joseph H. [1 ]
机构
[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Orthoped Surg, Boston, MA USA
[2] Univ Med Ctr Utrecht, Dept Orthoped Surg, Utrecht, Netherlands
[3] St Antonius Hosp, Dept Orthoped Surg, Utrecht, Netherlands
[4] OLVG, Dept Hematol Oncol, Amsterdam, Netherlands
[5] OLVG, Dept Orthoped Surg, Amsterdam, Netherlands
[6] Harvard Med Sch, Massachusetts Gen Hosp, Dept Orthoped Surg Orthoped Oncol Serv, 55 FruitStreet, Boston, MA 02114 USA
关键词
multiple myeloma; spinal cord compression; radiotherapy; surgery; neurology; retreatments; survival; INTERNATIONAL STAGING SYSTEM; RADIATION-THERAPY; WORKING GROUP; CRITERIA;
D O I
10.1177/21925682231188816
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study design Retrospective cohort study Objectives Up to 30% of Multiple Myeloma (MM) patients are expected to experience Epidural Spinal Cord Compression (ESCC) during the course of their disease. To prevent irreversible neurological damage, timely diagnosis and treatment are important. However, debate remains regarding the optimal treatment regimen. The aim of this study was to investigate the neurological outcomes and frequency of retreatments for MM patients undergoing isolated radiotherapy and surgical interventions for high-grade (grade 2-3) ESCC. Methods This study included patients with MM and high-grade ESCC treated with isolated radiotherapy or surgery. Pre- and post-treatment American Spinal Injury Association (ASIA) impairment scale and retreatment rate were compared between the 2 groups. Adjusted multivariable logistic regression was utilized to examine differences in neurologic compromise, pain, and retreatments. Results A total of 247 patients were included (Radiotherapy: n = 154; Surgery: n = 93). After radiotherapy, 82 patients (53%) achieved full neurologic function (ASIA E) at the end of follow-up. Of the surgically treated patients, 67 (64%) achieved full neurologic function. In adjusted analyses, patients treated with surgery were less likely to experience neurologic deterioration within 2 years (OR = .15; 95%CI .05-.44; P = .001) and had less pain (OR = .29; 95%CI .11-.74; P = .010). Surgical treatment was not associated with an increased risk of retreatments (OR = .64; 95%CI .28-1.47; P = .29) or death (HR = .62, 95%CI .28-1.38; P = .24). Conclusions After adjusting for baseline differences, surgically treated patients with high-grade ESCC showed better neurologic outcomes compared to patients treated with radiotherapy. There were no differences in risk of retreatment or death.
引用
收藏
页码:341 / 352
页数:12
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