Purpose: The broader use of MRI in patients (pts) with metastatic bone disease has led to an increase in detection of Impending Malignant Spinal Cord Compression (IMSCC), defined as an extra-dural malignant process distorting the theca without indenting or displacing the spinal cord. IMSCC pts are usually treated by palliative radiotherapy (P-RT) Our objective is to prospectively evaluate the patient characteristics and outcome of pts treated by P-RT for IMSCC. Materials: Pts with IMSCC in our institution are included in an ongoing prospective study, approved by our local ethics committee. The P-RT technical parameters (volume & dose) are left to physician's preference. All pts are evaluated prior to P-RT, at weeks 1 and 5, and then 3-monthly. The pts' mobility is evaluated using an in-house 3 point-scale (mobilising unaided; mobilising with aid; bed-bound). P-RT acute and late toxicity, pain and sphincter control are also documented, using a phone-based assessment. Results: From September 2007 to February 2010, 28 pts treated for IMSCC were included in this study. The median age at screening was 56 years (38- 85). The most common tumour primary sites were breast (7 pts), lung (4 pts), renal cell (4 pts) and prostate (3 pts), with a median time from initial diagnosis to IMSCC of 21 months (n= 25). All pts were diagnosed by full spine MRI/CT. The IMSCC site was mostly thoracic (12 pts) then lumbar spine (7 pts) and cervical, (5 pts). 4 pts had 2 sites of IMSCC. On pre-P-RT physical examination, 10 pts had some neurological deficit (data missing for 5 pts). Most pts were able to walk unaided (16 pts), 8 pts needed a walking aid and 4 were bed bound. Pain was found in 100% of pts (n=26). 2 of the 28 pts presented with bladder incontinence. All pts were treated by P-RT, using a standard 2-dimensional technique and various RT schedules (20 Gy/5 fr in 18 pts, 30 Gy/10 fr in 5 pts). P-RT follow-up demonstrated a spinal-related neurological deterioration (assessed via the mobility scale) in 4 pts at week 5 (16 remained stable, 1 improved, 5 other pts had died and data missing for 2 pts). At the 3 month follow-up mobility was stable (same as baseline) in 6 pts. There was an improvement in pain in 14 pts between initial assessment and week 1 (1 worsened, 2 remained stable; data missing for 11 pts). There was an improvement in pain in 15 pts between initial assessment and week 5 (1 worsened, 1 remained stable; 5 had died and data were missing for 6 pts). The median survival of pts with IMSCC was 4.2 months (127 days) from date of screening. Conclusions: A large proportion of pts with IMSCC present with neurological deficit despite reassuring radiology. The functional outcome of pts with IMSCC is poor with 81% of pts developing neurological deficit (assessed by the mobility scale) despite palliative RT. In addition, pts with IMSCC have poor survival. This increasing patient category (IMSCC) deserves dedicated clinical research.
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