Transcatheter Arterial Chemoembolization on Relapsed Metastatic Spinal Cord Compression after Radiotherapy

Objectives: The purpose of this study was to evaluate the effects of transcatheter arterial chemoembolization (TACE) on relapsed metastatic spinal cord compression (MSCC) after radiotherapy. Methods: From September 2014 to November 2018, 19 patients with 22 MSCC underwent TACE. We targeted the lesions with analgesic-resistant pain and neurologic deficit. The anticancer agents used were epirubicin, doxorubicin, and cisplatin, based on the primary lesion. In all cases, we performed TACE using Embosphere® (300–500 mm) after intra-arterial infusion chemotherapy. We repeated TACE as needed. Blood flow was altered with microcoils, if necessary. The following endpoints were evaluated for all lesions: pain relief, improvement of neurologic deficit, and objective tumor response. We defined complete symptom relief (CSR) as an achievement of pain relief and improvement of neurologic deficit, partial symptom relief (PSR) as an achievement of pain relief or improvement of the neurologic deficit but not both, and no symptom relief (NSR) as persistent pain and neurologic deficit. We defined the clinical response rate as (CSR + PSR)/(CSR + PSR + NSR). Objective response was estimated as follows: We defined complete response (CR) as a >50% decrease in tumor size, partial response (PR) as a < 50% decrease in tumor size, and stable response (SR) as no change in tumor size at follow-up. We defined the objective response rate as (CR + PR)/(CR + PR + SR). Results: We performed TACE for 45 sessions for 22 lesions. The treatment sites were as follows: 12 thoracic spines, eight lumbar spines, and two cervical spines. The outcomes with TACE were a clinical response rate of 86% (CSR: 10, PSR: 1, and NSR: 3) and an objective response rate of 68% (CR: 3, PR: 12, and SR: 7). We observed no severe adverse events. Conclusion: We recommend TACE for better pain relief and improvement of neurologic deficits from relapsed MSCC after radiotherapy.

Publication History

Article published online:
26 April 2021