Surgery Followed by Radiotherapy for the Treatment of Metastatic Epidural Spinal Cord Compression From Breast Cancer

Study Design. Retrospective analysis of breast cancer patients with metastatic epidural spinal cord compression (MESCC) undergoing surgery and radiation therapy. Objective. To assess feasibility and clinical outcome of multidisciplinary approach in breast cancer patients with MESCC. Summary of Background Data. Studies so far published in the setting of surgery and/or radiotherapy in the management of MESCC usually included many malignancies, without considering the different primary histology. However, when looking at prognostic variables of this therapy, histological type comes out as a major determinant of outcome. Methods. Twenty-three patients with symptomatic MESCC from breast cancer treated between January 2004 and April 2009 were included in this analysis. Twenty-six surgical procedures followed by radiotherapy were performed. Clinical outcome and local recurrence was evaluated by modified visual analog scale for pain, Frankel scale for neurologic deficit, and magnetic resonance imaging or computed tomography scans. Twenty-three cases (88.4%) had back pain before treatment with a visual analog scale score 6 or greater; neurologic deficit (FS A-D) was present in 19 cases (65.5%). Results. Complete remission of pain, lasting until death or progression of disease in another skeletal site, was obtained in 25/26 cases (96.1%). All patients had complete recovery of neurologic deficit. No major morbidity occurred. No patients had recurrence in the site of treatment. Median survival was 36 months (range, 3-60) and overall survival at one, three, and five years was 70%, 42%, and 34%, respectively. Conclusion. We provided evidence of surgery and radiotherapy to be feasible with limited morbidity. Clinical outcome has been highly satisfactory in terms of pain and local disease control. The discussion of each case within a multidisciplinary team is of central importance in defining the most appropriate therapeutic approach.