Extract
Question: In patients with metastatic epidural spinal cord
compression (MESCC), is direct decompressive surgery and radiation therapy
more effective than radiation therapy alone?Design: Randomized (allocation
concealed)*,
unblinded, controlled trial with a median follow-up of 93 to 102 days.*Information provided by author.Setting: 7 centers in the United States.Patients: 101 patients with cancer who were =18 years of age
(median age, 60 y; 70% men) and had magnetic resonance imaging evidence of
MESCC (true displacement of the spinal cord by an epidural mass), =1
neurological sign or symptom (including pain), and were not totally paraplegic
for =48 hours before study entry. Exclusion criteria were compression of
only the cauda equina or spinal roots; multiple discrete compressive lesions;
radiosensitive tumors such as lymphomas, leukemia, multiple myeloma, and
germ-cell tumors; preexisting or concomitant neurological problems not related
to MESCC; previous MESCC; previous spinal radiation precluding receipt of the
study dose; poor medical status precluding surgery; or expected survival of
<3 months. Follow-up was 100%.