• RT become the standard treatment for the most patients with MESCC
.
14
Advances
• CT late in the 1970s • MRI late in the 1980s • Surgical advance in 1980~90s
❖CAP :chest,abdomen and pelvis
.
9
• PET (positron emission tomography)
radiolabeled glucose molecule FDG
radionuclide study
.
10
FDG-PET ❖ Replace the CAP CT scan and bone
.
3
Epidemiology
.
4
• Metastatic Epidural Spinal Cord Compression (MESCC)
• Oligometastatic disease : involvement of three o fewer vertebrae and lack of other bone or visceral metastases
scan
❖ differentiate tumor from other processes ,such as osteoporosis and infection
.
11
Historical Review
• Elsberg 1916 more than 50% of all M.T. were secondary to breast carcinoma Surgically sectioning involved nerve root Surgically sectioning anterlateral spinal cord
.
17
Patchell,2005,Lancet
• Prospective Randomized Trial report • 101 pts with high-grade spinal cord
compression
.
18
129 100
9
3
regained ambulation(pts) survived time(days)
Diffusion and perfusion sequence(experiment)
.
7
.
8
• CT :
❖ assess bony quality for spinal implant placement
❖ the placement of pedicle screws navigating from images that CT and fluoroscopic
surgery plus RT RT alone
.
19
Surgery plus RT VS RT alone
.
20
Prognostic Variables
.
21
.
22
NOMS decision-making framework
• N: neurologic • O: oncologic • M: mechanical • S: systemic disease
.
15
Gilbert, 1978
• laminectomy plus RT V.S. RT alone
.
16
Loblow and Laperriere,1998
• Surgery :spinal instability bony compression
• RT: ambulatory patients • Surgery plus RT:nonambulatory patients
• Radiosensitivity
Radiosensitive tumors:multiple myeloma,lymphoma,breast carcinoma
Radioresistant tumors:colon,renal,and lung carcinoma,most sarcomas and melanoma
• Failed for : ❖Posterior laminectomy approach:indirected
decompression ❖No stabilization : ❖Delayed recognization:Widespread systemic
disease
.
13
1970s
• Radiotherapy(RT) equal efficacy and less morbidity
.
5
Presentation of the disease
• Biologic pain
• Radiculopathy
• Myelopathy
• Pain reflective of mechanical instability
.
6
Imaging
• MRI T1WI: hypointense (dark) T2-fat-suppressed :hyperintense(bright)
• Botson epidural venous plexus decompressing the epidural space by the means of laminectomy
.
12
1960s
• emergently operated on to decompress the spinal cord
Memorial Sloan-Kettering Cancer Center
.
23
.
24
Neurologic
• Biologic pain
• Radiculopathy
• Myelopathy
• Pain reflective of mechanical instability
.
25
Oncologic
脊柱转移恶性肿瘤治疗进展
New Therapeutics in Spine Metastases
张琥
.
1
• 5% to 10% of all cancer patients
• Traditional: Corticosteroids Radiotherapy(RT)
Epidemiology
.
2
ห้องสมุดไป่ตู้
Epidemiology