Colorectal cancer and spinal cord compression - Wednesday, July 18, 2012

Thank you to team 8 for bringing the case and to Dr. Raymond Jang for hosting today’s special Oncology morning report.

We discussed colorectal cancer and one of the oncological emergencies, namely spinal cord compression.

You can read more about colorectal cancer here.

For spinal cord compression, we discussed that functional status at presentation predicts outcome.  Urgent MR whole spine (not necessarily with contrast) is the preferred imaging modality (as clarifying the number of lesions may have therapeutic implications).  We discussed that in the acute setting, dexamethasone (10 mg IV x 1, followed by 16 mg/day [can be in divided doses]) and pain control are the usual medical treatment for the internist.  However, these patients require URGENT radiation oncology assessment and/or neurosurgical intervention.

We discussed about a randomized control trial that suggested selected patients with a single site of lesion may benefit (better neurological outcome) from neurosurgical intervention and radiation when compared to radiation alone.  The trial (Patchell RA et al.  Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.  Lancet. 2005 Aug 20-26;366(9486):643-8.) can be accessed here.  The primary outcome was the ability to walk and statistically significantly more patients in the surgery followed by radiation group (84%) achieved this outcome than the radiation only group (57%, p=0.001).

However, this is not the only consideration and expert opinion from radiation oncology and neurosurgical colleagues will be helpful.