Factors affecting the recovery of spinal functions in patients with spinal metastatic carcinoma

Sihai LIAO; Zhixiong YANG; Zhi TANG

ABSTRACT

BACKGROUND:

Tumor spinal metastasis is often complicated with pain,limitations in movement, paralysis and poor prognosis.

OBJECTIVE:

To investigate the factors affecting the recovery of the spinal functions in patients with spinal metastatic carcinoma and its therapeutic methods so as to improve the living quality of the patients with a terminal cancer.

DESIGN:

A case-controlled observation.

SETTING:

The Department of Tumor and Department of Radiotherapy of the Affiliated Hospital of Guangdong Medical College.

PARTICIPANTS:

We selected 162 patients with spinal metastatic carcinoma with different degrees of paralysis who received treatment at the Department of Oncology and the Department of Radiotherapy of the Affiliated Hospital of Guangdong Medical College between March 1992 and June 2001. They participated in this experiment voluntarily.

METHODS:

①Radiotherapy and chemotherapy; All the patients were given symptomatic treatment with simple radiotherapy or a combined therapy of simple radiotherapy and chemotherapy, in which the dose of chemotherapy was 2 Gy/time,5 times a week,3 weeks in total. A combined method was used for chemotherapy according to the nature of the different primary tumors. The chemotherapy was conducted for 3 therapeutic courses in average ranging from 2 to 6 courses of treatment with 21 days for each course. ② Physical rehabilitation therapy included exercise therapy, massage (twice/day), functional electrical stimulation (once a day),bladder training and toilet training (once or twice every day), 10 days as a therapeutic course, 3 successive therapeutic courses in total. After the treatment, analgesic pain, muscle power of the limbs and the recovery of defecation function were observed.MAIN OUTCOME

MEASURES:

Pain-alleviating, muscle power of the limbs and the recovery of defecation function after the operation.

RESULTS:

Totally 162 patients with spinal metastasis carcinoma were recruited, and all the patients entered the stage of result analysis at the end of therapy with no loss in the midway. ① Pain complete alleviating was in 97 cases (59.88%); no alleveclting in 0 case. ② The condition was remarkably improved in 127 cases(78.40%), and it was not improved in 35 cases (21.60%). The improved rate of muscle power of the patients with one focus and 2 adjacent focuses was 92.98%. The improved rate of the patients with multiple foci was 64.59%. The muscle power of the patients with a disease history of less than 2 weeks was improved remarkably, but there was no change in muscle power in patients with a disease history of more than 2 months. CT or MRI showed that spinal cord at the affected segment of the 21 patients suffered severely compression before the treatment, and only 2 cases were improved in muscle power, with no other changes.③The defecation function of 162 patients all became normal.

CONCLUSION:

Patients with spinal metastatic carcinoma complicated with paralysis have different degrees of relief and amelioration in pain,muscle power of the limbs and defecation function after radiotherapy,chemotherapy and synthetic rehabilitation therapy. Factors affecting the recovery of spinal function mainly included the length of disease course,compressed degree of the spinal cord, the quantity of metastatic focus, the health status of the patients and therapeutic time and the quality of primary rehabilitation and so on. Mental help to the patients should be paid attention to so as to improve the quality of life at the same time.