Intradural Cauda Equina Metastases: A Systematic Review of Clinico-radiological Features, Management, and Treatment Outcomes.


Journal

Anticancer research
ISSN: 1791-7530
Titre abrégé: Anticancer Res
Pays: Greece
ID NLM: 8102988

Informations de publication

Date de publication:
04 2022
Historique:
received: 30 01 2022
revised: 11 02 2022
accepted: 14 02 2022
entrez: 29 3 2022
pubmed: 30 3 2022
medline: 5 4 2022
Statut: ppublish

Résumé

Intradural cauda equina metastases (ICEM) are rare tumors that reduce functional status. Surgery and radiation are feasible and effective treatments but may have debilitating complications. We systematically reviewed the literature on ICEMs. PubMed, Scopus, Web of Science, and Cochrane were searched for studies reporting clinical data of patients with ICEMs. Clinical characteristics, management strategies, and treatment outcomes were analyzed. We included 40 studies comprising 123 patients. Median age was 57 years. The most frequent primary tumors were lung (18.7%), breast (13%), and renal carcinomas (11.4%). Median time from primary tumor diagnosis to ICEMs' presentation was 36 months. The most common presenting symptoms were lower back pain (74%) and motor deficits (62.6%), with acute cauda equina syndrome documented in 36 patients (29.3%). Most lesions were diagnosed at magnetic resonance imaging (56.9%) or computed tomography myelography (32.5%). All cases were treated with decompressive laminectomy and tumor resection, with partial resection (82.1%) more often than complete (15.4%). Adjuvant radiotherapy (83.7%) and/or chemotherapy (10.6%) were often administered. Most patients experienced post-treatment symptom improvement (86.2%) and favorable radiological response (82.9%). ICEM recurrences were reported in 4 cases (8.5%) with median local tumor control of 7 months. At last follow-up, most patients were dead (62.9%) with median overall-survival of 10 months. Patients with ICEMs have poor prognoses and significant tumor burden. Surgery and locoregional radiotherapy may offer optimal clinical and radiological outcomes but have a limited role in improving local tumor control and overall survival.

Sections du résumé

BACKGROUND/AIM
Intradural cauda equina metastases (ICEM) are rare tumors that reduce functional status. Surgery and radiation are feasible and effective treatments but may have debilitating complications. We systematically reviewed the literature on ICEMs.
MATERIALS AND METHODS
PubMed, Scopus, Web of Science, and Cochrane were searched for studies reporting clinical data of patients with ICEMs. Clinical characteristics, management strategies, and treatment outcomes were analyzed.
RESULTS
We included 40 studies comprising 123 patients. Median age was 57 years. The most frequent primary tumors were lung (18.7%), breast (13%), and renal carcinomas (11.4%). Median time from primary tumor diagnosis to ICEMs' presentation was 36 months. The most common presenting symptoms were lower back pain (74%) and motor deficits (62.6%), with acute cauda equina syndrome documented in 36 patients (29.3%). Most lesions were diagnosed at magnetic resonance imaging (56.9%) or computed tomography myelography (32.5%). All cases were treated with decompressive laminectomy and tumor resection, with partial resection (82.1%) more often than complete (15.4%). Adjuvant radiotherapy (83.7%) and/or chemotherapy (10.6%) were often administered. Most patients experienced post-treatment symptom improvement (86.2%) and favorable radiological response (82.9%). ICEM recurrences were reported in 4 cases (8.5%) with median local tumor control of 7 months. At last follow-up, most patients were dead (62.9%) with median overall-survival of 10 months.
CONCLUSION
Patients with ICEMs have poor prognoses and significant tumor burden. Surgery and locoregional radiotherapy may offer optimal clinical and radiological outcomes but have a limited role in improving local tumor control and overall survival.

Identifiants

pubmed: 35346985
pii: 42/4/1661
doi: 10.21873/anticanres.15643
doi:

Types de publication

Journal Article Review Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1661-1669

Informations de copyright

Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Auteurs

Paolo Palmisciano (P)

Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy; paolo.palmisciano94@gmail.com.

Saif E Zaidi (SE)

University of Paris School of Medicine, Paris, France.

Nathan A Shlobin (NA)

Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.

Navraj S Sagoo (NS)

Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.

Othman Bin Alamer (O)

King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.

Gianluca Scalia (G)

Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi", Catania, Italy.

Gianluca Ferini (G)

Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy.

Giuseppe E Umana (GE)

Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.

Salah G Aoun (SG)

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.

Ali S Haider (AS)

Texas A&M University College of Medicine, Houston, TX, U.S.A.
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A.

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