Orla McArdle, Presenter: Nothing to Disclose

Cormac Small, Abstract Co-Author: Nothing to Disclose

Angela Clayton-Lea, Abstract Co-Author: Nothing to Disclose

Conor D. Collins MBBCh, Abstract Co-Author: Nothing to Disclose

Michael Moriarty, Abstract Co-Author: Nothing to Disclose

Pierre Thirion, Abstract Co-Author: Nothing to Disclose

Spinal cord compression is an oncological emergency frequently treated with radiotherapy and/or decompressive surgery. Neurological outcome is associated with the degree of deficit at presentation and median survival is reported at 3.5months.1 In contrast, the significance of impending spinal cord compression has not been clearly defined. There is little or no data available regarding median survival or clinical presentation. We conducted a prospective study comparing patient characteristics and median survival in patients with spinal cord compression and impending spinal cord compression.

All patients attending our hospital with a diagnosis of actual or impending spinal cord compression on magnetic resonance imaging (MRI) of the entire spine from January 2006 to March 2007 were included in this analysis. Patient characteristics and clinical examination at presentation were recorded in standardised format. All patients received radiotherapy within 24 hours of referral to our hospital. The majority were treated with 20Gy in 5 fractions delivered on a cobalt machine over one week. Treatment details and survival data were also collected.Data was analysed using Microsoft Excel software. Survival was calculated from date of inclusion in the study to date of death or to 31.3.2007. A chi-square analysis was performed to compare proportions in the two groups. Kaplan-Meier statistics were used to analyse median survival.

To date 148 patients have been included in the study, 109 (74%) with confirmed spinal cord compression and 39 (26%) with impending spinal cord compression. The most frequently occurring underlying malignancies were: prostate 29 (20%), breast 28 (26%), lung 17 (11%) and multiple myeloma 12(8%). Median time from diagnosis of primary malignancy to diagnosis of spinal cord compression was 22.5 months and 23 months for those with confirmed and impending spinal cord compression respectively.81% of patients reported pain as a presenting symptom. Duration of pain was 9.5 in cases of spinal cord compression and 7 months for those with impending cord compression. Patients with cord compression were more likely to have multiple vertebral levels affected. Median survival time was 111 days for cord compression and 128 days for cases of impending cord compression. Complete statistical analysis will be available at the time of presentation.

Our preliminary analysis indicates that presenting patient characteristics and radiotherapy treatment outcomes are similar for cases of confirmed spinal cord compression and for impending spinal cord compression. These data indicate that it is reasonable to treat impending spinal cord compression with the same approach as actual spinal cord compression.

McArdle, O, Small, C, Clayton-Lea, A, Collins, C, Moriarty, M, Thirion, P, Spinal Cord Compression versus Impending Spinal Cord Compression: Prospective Study of Patient Characteristics and Survival.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/6001549.html