Surgical decompression of malignant spinal cord compression (MSCC) in lung cancer: the Manchester experience

Abstract

Introduction: Ambulatory rates post decompressive surgery and radiotherapy were superior to radiotherapy alone in a randomised trial, although lung cancer patients tend to have poorer outcome. The modified Tokuhashi score (mTS) is one of the most commonly used predictive systems for spinal metastases, used as a decisionmaking tool. Methods: Data was collected retrospectively from an electronic database maintained by the MSCC coordinator from 2014-2020. Cases undergoing decompressive surgery were interrogated for median survival (MS) and potential prognostic factors including mTS, ACE comorbidity, histological type and mutational status. Results: 27 MSCC lung patients underwent decompressive surgery. Median age 67 (range 45–80), 4 patients were PS 0, 18 PS 1 and 5 PS 2. See figure for histological subtypes. 25 patients have died, 2 remain on follow-up with MS 23.4 weeks (range 5.6–170 weeks) and 6-month survival 48%. Although there was no difference in prognosis according to mTS, those with a higher ACE comorbidity score had worse survival (see figure). MS in adenocarcinoma patients (n=13) was 42.9 weeks, in squamous carcinoma (n=7) 20.1 weeks. MS in 3 cases with EGFR mutation was 63.1 weeks, 1 ALK1 translocation was 76.1 weeks, 1 V600E was >170 weeks. None of these mutation results were available pre-op. 10/21 new presenters with stage 4 disease had pre-op histology. 19/27 patients had spinal instability. Conclusion: This audit suggests considering ACE comorbidity in addition to widely used mTS. More than 50% of patients did not have histology. However, pre-surgical biopsies may not always be feasible if spinal instability or neurological symptoms but where possible should be sought. An alternate option includes blood ctDNA testing to identify better prognosis patients and increase access to optimal treatments. In the modern era of SACT for stage 4 disease, early engagement of lung oncology team is invaluable in patient selection. Disclosure: No significant relationships. [Figure presented]