South Med J 2017 09;110(9):586-593
From the Departments of Internal Medicine, Radiation Oncology, and Neurosurgery, Augusta University, Augusta, Georgia, the Dattoli Cancer Center, Sarasota, Florida, the Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, and the Department of Radiation Oncology, Texas Oncology, Waco.
Cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Metastatic disease can promote end-organ dysfunction and even failure through mass effect compression of various vital organs including the spinal cord. In such cases, prompt medical attention is needed to restore neurological function, relieve pain, and prevent permanent damage. The three therapeutic approaches to managing metastatic spinal cord compression include corticosteroids, surgery, and radiation therapy. Although each may improve patients' symptoms, their combination has yielded the best outcome. In cancer patients with clinical suspicion of spinal cord compression, dexamethasone should be initiated followed by surgical decompression, when possible, and radiation. The latter becomes the preferred treatment in patients with inoperable disease.