Epidural spinal cord compression from metastatic tumor: Results with a new treatment protocol
Version of Record online: 7 OCT 2004
Copyright © 1980 American Neurological Association
Annals of Neurology
Volume 8, Issue 4, pages 361–366, October 1980
How to Cite
Greenberg, H. S., Kim, J.-H. and Posner, J. B. (1980), Epidural spinal cord compression from metastatic tumor: Results with a new treatment protocol. Ann Neurol., 8: 361–366. doi: 10.1002/ana.410080404
- Issue online: 7 OCT 2004
- Version of Record online: 7 OCT 2004
- Manuscript Accepted: 2 FEB 1980
- Manuscript Revised: 24 JAN 1980
- Manuscript Received: 16 NOV 1979
Eighty-three patients with epidural spinal cord compression from metastatic cancer were treated with high-dose adrenocorticosteroids and a new radiation fractionation protocol. Only those patients were included who had complete or almost complete block on myelography and who had not received prior radiation therapy to the area of compression. Patients were given 100 mg of dexamethasone intravenously at the time of diagnosis and 500 rads of radiation on each of the first three days. After a four-day rest, radiation therapy was continued at 300 rads to a total dose of 3,000 rads.
The effects of this new protocol on the patient's motor abilities did not differ from those of previous protocols, namely, 47 of 83 patients (57%) were ambulatory after treatment, with no responses in patients totally paraplegic before treatment. However, early administration of high doses of dexamethasone substantially ameliorated pain in the majority of patients, with relief often coming within hours after the drug was given. On the basis of these data, we recommend high doses of adrenocorticosteroids combined with radiation therapy for acute treatment of spinal cord compression. The optimum fractionation schedule for radiation therapy is not established.