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Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours

Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours
Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours
Aim: to review the management and clinical outcome of 10 patients, presenting to a single centre with symptoms and signs of spinal cord or cauda equina compression secondary to epidural metastatic disease from a testicular germ cell cancer.
Methods: clinical data regarding presenting history, physical examination, staging investigations, treatment and clinical outcome were retrospectively obtained from patient records.
Results: eight patients exhibited neurological deficits at the time of initial presentation of germ cell cancer or as a first manifestation of relapse following dog leg irradiation. Four of these cases were managed with chemotherapy alone, with excellent neurological recovery, whilst four underwent decompressive laminectomy – in three cases prior to referral and in one case after commencing chemotherapy. Five of the eight patients relapsed. Four required further chemotherapy (high dose in two cases). The remaining patient underwent thoracic surgery, with resection of teratoma differentiated. Six of the eight patients are currently alive and disease free. Two patients had chemorefractory disease and died, though one was treated in the pre-cisplatin era. Two patients presented with cord compression as a feature of disease relapse following chemotherapy, and were managed with radiotherapy alone in an attempt to achieve local disease control and limit neurological dysfunction. However, both subsequently died with progressive disease.
Conclusion:epidural spinal cord or cauda equina compression is a rare complication of metastatic germ cell cancer, which can be successfully managed in chemo-naive patients with good neurological outcome.
cauda equina compression, chemotherapy, epidural metastatic disease, malignant germ cell tumours, radiotherapy, spinal cord compression
0936-6555
481-490
Gale, J.
79e457d2-25af-4829-9a01-5ef4dc12d8fd
Mead, G.M.
8a97f978-9c66-4a16-bb03-dd83d20b06a0
Simmonds, P.D.
27d4c068-e352-4cbf-9899-771893788ade
Gale, J.
79e457d2-25af-4829-9a01-5ef4dc12d8fd
Mead, G.M.
8a97f978-9c66-4a16-bb03-dd83d20b06a0
Simmonds, P.D.
27d4c068-e352-4cbf-9899-771893788ade

Gale, J., Mead, G.M. and Simmonds, P.D. (2002) Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours. Clinical Oncology, 14 (6), 481-490. (doi:10.1053/clon.2002.0167).

Record type: Article

Abstract

Aim: to review the management and clinical outcome of 10 patients, presenting to a single centre with symptoms and signs of spinal cord or cauda equina compression secondary to epidural metastatic disease from a testicular germ cell cancer.
Methods: clinical data regarding presenting history, physical examination, staging investigations, treatment and clinical outcome were retrospectively obtained from patient records.
Results: eight patients exhibited neurological deficits at the time of initial presentation of germ cell cancer or as a first manifestation of relapse following dog leg irradiation. Four of these cases were managed with chemotherapy alone, with excellent neurological recovery, whilst four underwent decompressive laminectomy – in three cases prior to referral and in one case after commencing chemotherapy. Five of the eight patients relapsed. Four required further chemotherapy (high dose in two cases). The remaining patient underwent thoracic surgery, with resection of teratoma differentiated. Six of the eight patients are currently alive and disease free. Two patients had chemorefractory disease and died, though one was treated in the pre-cisplatin era. Two patients presented with cord compression as a feature of disease relapse following chemotherapy, and were managed with radiotherapy alone in an attempt to achieve local disease control and limit neurological dysfunction. However, both subsequently died with progressive disease.
Conclusion:epidural spinal cord or cauda equina compression is a rare complication of metastatic germ cell cancer, which can be successfully managed in chemo-naive patients with good neurological outcome.

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More information

Published date: 2002
Keywords: cauda equina compression, chemotherapy, epidural metastatic disease, malignant germ cell tumours, radiotherapy, spinal cord compression

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Local EPrints ID: 26318
URI: http://eprints.soton.ac.uk/id/eprint/26318
ISSN: 0936-6555
PURE UUID: b09231fd-5563-4afb-b2a2-d66ccfb5342d

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Date deposited: 20 Apr 2006
Last modified: 15 Jul 2019 19:14

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