Outcomes after irradiation of epidural spinal cord compression due to metastatic thyroid cancer

Aim: Epidural spinal cord compression (ESCC) from thyroid cancer is uncommon. This study aimed to contribute to the identification of the most appropriate treatment for these patients. Patients and Methods: Fourteen patients receiving irradiation alone were retrospectively evaluated. Results: Improvement of motor deficits occurred in 36% of patients, further progression was prevented in another 43% (overall response=79%). One of six nonambulatory patients (17%) became ambulatory. The 12-month rate of freedom from in-field recurrence was 85%; long-course irradiation was superior to short-course irradiation (100% vs. 67%, p=0.11). The 12-month survival rate was 41%. Age <70 years (p=0.007), no other metastases (p=0.007), differentiated cancer (p<0.001), ability to walk (p=0.015), affection of 1-3 vertebrae (p<0.001) and better performance score (p=0.007) were associated with survival. Conclusion: Irradiation resulted in a good response. Neurosurgery appears required for nonambulatory patients to restore walking ability. Long-course irradiation resulted in excellent long-term freedom from infield recurrence and appears preferable for patients with favorable survival prognoses.