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Chemoembolization for Symptomatic Metastatic Epidural Spinal Cord Compression Refractory to Re-radiotherapy
CardioVascular and Interventional Radiology ( IF 2.9 ) Pub Date : 2021-08-02 , DOI: 10.1007/s00270-021-02930-1
Joichi Heianna 1 , Wataru Makino 1 , Masafumi Toguchi 1 , Takeaki Kusada 1 , Tomotaka Iraha 1 , Kazuki Ishikawa 1 , Shota Takehara 1 , Hitoshi Maemoto 1 , Takuro Ariga 1 , Sadayuki Murayama 1
Affiliation  

Purpose

To evaluate the efficacy of chemoembolization for inoperable metastatic epidural spinal cord compression (MESCC) refractory to re-radiotherapy.

Methods

Nineteen consecutive patients with recurrent MESCC after re-radiotherapy who had undergone chemoembolization were retrospectively analyzed. Outcome measures were pain relief rate, neurological improvement rate, objective response rate, and adverse events. MESCC degree classification was assessed using Bilsky grades. Pain assessment was performed using Numerical Rating Scale, and neurological function was evaluated using the Frankel classification.

Results

The median follow-up period was 7 (range 2–44) months. All participants had MESCC grade 2 or higher and had severe pain. Fifteen patients (79%) had neurological deficits, and ten had Frankel classification C and five had D. Symptoms were relieved in almost all patients the day following chemoembolization. Pain relief was achieved in 18 of 19 (95%) patients; the median decrease in Numerical Rating Scale score was 8 (range 0–10; p < 0.001). Neurological improvement was achieved in 11 of 15 patients (73%); the median increase in Frankel classification was 1 (range 0–2; p = 0.006). Ten of 19 (53%) patients showed a reduction in MESCC; the median decrease in Bilsky grade was 1 (range 0–2; p = 0.005). There was no correlation between the change in Bilsky grade and pain relief (p = 0.421). However, the decrease in Bilsky grade significantly improved neurological symptoms (p = 0.01). No serious adverse events occurred.

Conclusion

Chemoembolization may be a useful palliative treatment modality for MESCC refractory to re-radiotherapy.

Level of Evidence

Level 3b, Follow up Study.



中文翻译:

有症状转移性硬膜外脊髓压迫再放疗难治性化疗栓塞

目的

评估化疗栓塞对无法手术的转移性硬膜外脊髓压迫 (MESCC) 再放疗无效的疗效。

方法

对 19 名接受化疗栓塞的再放疗后复发性 MESCC 患者进行回顾性分析。结果指标为疼痛缓解率、神经系统改善率、客观反应率和不良事件。MESCC 学位分类使用 Bilsky 等级进行评估。使用数字评定量表进行疼痛评估,使用 Frankel 分类评估神经功能。

结果

中位随访期为 7(范围 2-44)个月。所有参与者的 MESCC 等级为 2 级或更高,并且有严重的疼痛。15 名患者 (79%) 有神经功能缺损,10 名患者为 Frankel C 级,5 名患者为 D。在化疗栓塞后的第二天,几乎所有患者的症状都得到了缓解。19 名 (95%) 患者中有 18 名实现了疼痛缓解;数字评定量表得分的中位数下降为 8(范围 0-10;p  < 0.001)。15 名患者中有 11 名(73%)获得了神经学改善;Frankel 分类的中位数增加为 1(范围 0-2;p  = 0.006)。19 名 (53%) 患者中有 10 名显示 MESCC 减少;Bilsky 等级下降的中位数为 1(范围 0-2;p = 0.005)。Bilsky 分级的变化与疼痛缓解之间没有相关性 ( p  = 0.421)。然而,Bilsky 等级的降低显着改善了神经系统症状(p  = 0.01)。没有发生严重的不良事件。

结论

化疗栓塞可能是一种有用的姑息治疗方式,用于对再放疗无效的 MESCC。

证据水平

级别 3b,后续研究。

更新日期:2021-08-02
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