Long-Term Follow-Up of Patients with Metastatic Epidural Spinal Cord Compression from Breast Cancer Treated with Surgery Followed by Radiotherapy

Objective To evaluate role of surgery plus radiotherapy (RT) in patients with metastatic epidural spinal cord compression from breast cancer with a follow-up >10 years. Methods The study included 23 patients treated between 2004 and 2008. Surgical treatment was performed in patients with good performance status, limited metastatic disease, and progressive neurologic deficit and/or intractable pain. RT was performed delivering a median total dose of 30 Gy in 10 fractions. Clinical outcome was evaluated using the modified visual analog scale for pain, Frankel grade for neurologic deficit, and magnetic resonance imaging before and after treatments and every 3 months thereafter. Results Minimal resection was performed in 17.4% of patients, curettage in 47.8%, and total tumorectomy in 34.8%, followed by RT in 78.3%. Pain remission was obtained in 98% of patients, and recovery of neurologic function was obtained in 92.9%. Median follow-up time was 153 months (range, 128–209 months). No relapse at site of treatments occurred. Median overall survival time was 47 months (95% confidence interval 33–114 months), and 2-, 5-, and 10-year overall survival rates were 81% (±8.6%), 42.9% (±10.8%), and 28.6% (±9.9%). On univariate analysis, performance status, type of surgical resection, breast cancer phenotype, and presence of other bone metastases were recorded as influencing survival; the last-mentioned was also confirmed in multivariate analysis. Conclusions Surgery plus RT is a safe and feasible treatment with limited morbidity. In selected patients with good performance status, positive hormonal receptors, and limited metastatic disease, surgical intervention should be strongly considered early on.