Oncological Emergencies Dr. Gary Harding md, frcpc

Definitive choice

Portal 8 cm wide

Centered on spine

Extends one to two vertebral bodies above and below the epidural metastasis

Relieves pain in most cases

• Relieves pain in most cases

• Post-neurological function usually determines response

• Response most associated with tumor type and radiosensitivity; eg. lymphoma

• Dosing 20 to 40 Gy in 5 to 20 fractions

• Popular

• 30 Gy in 10 fractions

Surgery

• Changing role

• Historically posterior vertebral decompression was done

• No survival benefit with or without radiation15

Better techniques today allow aggressive approach

• Better techniques today allow aggressive approach

• Gross spinal tumor resection with vertebral reconstruction now possible

• Experienced surgeon required

Recent controlled trial comparing aggressive surgery followed by radiation vs. radiation alone16

• Recent controlled trial comparing aggressive surgery followed by radiation vs. radiation alone16

• Improvement in surgery+rads

• Days remained ambulatory (126 vs. 35)
• Percent that regained ambulation after therapy (56% vs. 19%)
• Days remained continent (142 vs. 12)
• Less steroid dose, less narcotics
• Trend to increase survival