Pessina F, et al. - This study was designed to determine the role of surgery plus radiotherapy in metastatic epidural spinal cord compression (MESCC) breast cancer (BC) patients with a follow-up longer than 10 years. Findings demonstrated that surgery plus radiotherapy was a safe and feasible treatment with limited morbidity. In selected patients with good performance status, positive hormonal receptors, and limited metastatic disease, they strongly recommended considering initiating treatment with surgical intervention.

Methods

• From 2004 to 2008, 23 patients treated were included. In patients with good performance status, limited metastatic disease and progressive neurologic deficit and/or intractable pain, surgical treatment was performed.
• RT delivering a median total dose of 30 Gy in 10 fractions was performed.
• To assess clinical outcome, researchers used the modified visual-analog-scale (VAS) for pain, the Frankel scale (FS) for neurologic deficit, and MRI before, after treatments and every 3 months thereafter and.

Results

• Researchers performed minimal resection in 17.4% of patients, curettage in 47.8%, and total tumorectomy in 34.8% followed by radiotherapy in 78.3%.
• They obtained pain remission in 98% of patients and recovery of neurologic function in 92.9%.
• For the patients, the median follow-up time was 153 months (range 128-209 months).
• They observed no relapse in site of treatments occurred. As per observations, the median OS time, 2, 5, and 10 years OS rates were 47 months (95%CI 33-114 months), 81% (±8.6%), 42.9% (±10.8%), and 28.6% (±9.9%).
• Univariate analysis suggested that performance status, kind of surgical resection, BC phenotype, and presence of other bone metastases were influencing survival, the latter was also confirmed in multivariate ones.