Medical Student Stanford University School of Medicine California University of Science and Medicine Ontario, CA, US
Introduction: Intramedullary spinal cord metastases (ISCMs) are secondary tumors arising in the spinal cord parenchyma, most often accompanied by devastating neurologic consequences and poor prognosis. Although they were previously considered rare malignancies, their incidence is now on the rise. Thus, a greater evidence base is urgently needed for guiding management.
Methods: The electronic health record at our institution was queried for patients diagnosed with ISCM. We retrospectively reviewed the resulting patient charts and extracted information pertaining to demographics, oncological disease course, ISCM characteristics, management strategy, and clinical follow-up.
Results: Thirty-nine patients presented with ISCM to our institution, comprised of 12 (30.8%) men and 27 (69.2%) women, with a mean age of 56.8 (range: 29.3-89.0) years old at ISCM diagnosis. The primary cancer distribution was 15 breast, 12 lung, 2 renal, 2 gastrointestinal, 2 sarcoma, and 6 other, with time from primary cancer to ISCM diagnosis averaging 4.7 (median: 2.7, range: 0.0-30.1) years. The vast majority of the cohort (31 of 39 patients) presented with a singular ISCM. Two patients had extensive, practically unquantifiable spinal cord disease. In 47 distinct ISCMs across 37 patients, 13 were located in the cervical spinal cord (C1-C8), 16 were upper- and mid-thoracic (T1-T9), and 18 were thoracolumbar (T10-CM [conus medullaris]). Of 37 patients with known first-line treatment status, 19 underwent conventional external beam radiotherapy, 6 underwent stereotactic radiosurgery, and 6 underwent surgical resection as initial management. Adjuvant radiation was administered to 4 of the 6 first-line surgery patients. One additional patient underwent surgical resection post-radiotherapy. The remaining 6 patients were subject to medical, expectant, or palliative management. Median follow-up time and median overall survival from ISCM diagnosis were 125 (IQR: 40-442) months and 14 (95% CI [8, 34]) months, respectively.
Conclusion : In 27 years (1998 to 2024) at an NCI-designated comprehensive cancer center, 39 patients presenting with ISCM were retrospectively reviewed. Here, we reported characteristics and management strategies in one of the largest single-institution ISCM cohorts to date.
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