Background Clinical trials have shown surgery to be superior to radiotherapy for patients with metastatic spinal cord compression (MSCC). We present our results following the establishment of a centralised MSCC service, the aim of which is to coordinate the pathway of patients with MSCC within 15 hospitals that serve a population of 3.5 million people.
Aims The primary aim of this study was to determine the survival time following treatment for metastatic spinal cord compression. The secondary aim was to compare our results against survival times quoted in the medical literature.
Methods Data was prospectively collected and analysed for all patients referred with confirmed MSCC in 2014 and 2015. Patients were triaged by the oncologist and spinal surgeon, based on prognosis and performance status and categorised into four subtypes: (1) best supportive care (2) systematic anti-cancer therapy (3) spinal surgery and post-operative radiotherapy (4) radiotherapy alone.
Results 1253 patients were referred to the MSCC service, of which 540 (43%) had confirmed MSCC. 73 patients (14%) received best supportive care (median survival of 32 days), 24 patients (4%) had systemic anti-cancer therapy (median survival of 637 days), 89 patients (16%) had surgery (median survival of 377 days) and 354 patients (66%) had radiotherapy (median survival of 62 days).
Conclusion Our results of 377 days compare favourably to studies by Patchell and Fehling, which found median survivals of 126 days and 230 days respectively following surgery. Our data strongly supports the use of decompressive spinal surgery with instrumented stabilisation for MSCC in carefully selected patients.
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