Radiation therapy of metastatic spinal cord compression. Multidisciplinary team diagnosis and treatment.

PURPOSE: To evaluate the effectiveness of a multidisciplinary approach to spinal cord compression (SCC) in accordance with prospective protocol, providing a uniform approach to diagnosis, decision making concerning optimal treatment modality in any particular case of SCC, treatment performance and evaluation of treatment results. The SCC patients treated by radiation therapy are described. MATERIALS AND METHODS: Patients with SCC were examined and treated by a multidisciplinary team consisting of a neurologist, radiologist, oncologist, orthopedic surgeon, and neurosurgeon. Seventy-nine patients for whom radiation was recommended received a 30 Gy radiation dose to a compression-causing mass and course of high dose dexamethasone. Three fractions of 5 Gy and 5 fractions 3 Gy each were delivered by Co60 or 8 MV photon beam in 12 days. Treatment outcome was essentially evaluated by ambulation capabilities which were considered to be the main problem of SCC. Changes in other neurologic motor, sensory and autonomic disturbances were also evaluated. RESULTS: Seventy-two percent of the patients were already non-ambulatory at diagnosis. The first symptom was motor deficiency in only 33% of them while in all other cases it was pain. Ambulation capability was the main prognosticator of treatment outcome; 90% of patients who were ambulatory before treatment remained so while 33% of the non-ambulatory patients regained their ability to walk. The grade of motor disturbance was also an important variable: among the non-ambulatory patients, 50% of the paretic but only 14% of the plegic ones became ambulatory. Overall, 51% of the study patients were ambulatory after undergoing radiation. The ambulatory state after treatment was the main predictor for survival. CONCLUSION: Close cooperation of a multidisciplinary team in diagnosis and treatment according to the above protocol enabled the achievement of good results of radiation treatment in SCC. Early diagnosis and early treatment should further enhance therapeutic outcome.

Combination chemotherapy using cyclophosphamide, vincristine, methotrexate, 5-fluorouracil, and prednisone in solid tumors.

Three hundred and ninety-eight patients with disseminated solid tumors other than breast cancer, were treated with a combination chemotherapy protocol utilizing cyclophosphamide, vincristine sulfate, methotrexate, 5-fluorouracil, and prednisone. Three hundred and eighty were evaluable (95.5%). Partial or complete tumor regressions were noted in 73 of 380 (19%) evaluable patients. Response to therapy was associated with a prolongation and survival. The largest tumor categories were lung, ovary, and gastrointestinal. The proportion of complete plus partial responses in evaluable lung cancer patients was 40/236 (17%), compared to 20/44 (45%) for ovarian cancer patients and 6/39 (15%) for gastrointestinal tumors. Of the patients who could be evaluated for toxicity, 47% had minimal or no toxicity, 51% had moderate to severe toxicity, and 2% had life threatening toxicity. Virtually all patients were treated and managed as outpatients.

Extreme thrombocytosis associated with malignancy.

A case is described in which a platelet count of 6,000,000/mm3 occurred in association with adenocarcinoma of the lung and remitted following definitive radiotherapy of the primary lesion. Despite the magnitude of the platelet elevation, thrombohemorrhagic phenomena were not observed. Extreme thrombocytosis of this magnitude is rare in either primary or secondary disorders of thrombopoiesis. The occurrence of unexplained thrombocytosis demands the exclusion of malignancy.