Radiotherapy is effective for metastatic spinal cord compression in patients with epithelial ovarian cancer

Synchronous skull base and spinal metastases in a patient with treatment-resistant, high-grade serous adenocarcinoma of tubo-ovarian origin

Brain metastases (BMs) arising from ovarian cancer remain rare. Spinal cord metastases are even rarer, accounting for just 0.4% of total metastatic spinal cord compressions. In this report, we describe a case of a woman in her 70s who developed sequential brain and spinal cord metastases during her treatment for high-grade serous ovarian cancer, without a germline or somatic BRCA mutation. Following completion of neoadjuvant chemotherapy, interval debulking surgery and adjuvant chemotherapy, relapsed disease was ultimately identified as a single BM, curiously mimicking an acoustic neuroma. Subsequently, spinal cord metastases rapidly developed. Throughout, multidisciplinary team meetings guided decisions on patient management. In this report, we highlight the rarity of such a presentation and discuss the possible role of disease pathophysiology, associated systemic anticancer therapy resistance, and treatment possibilities for both cerebral and spinal metastases.

Clinical Characteristics and Prognostic Analysis of Gynecologic Cancer with Spinal Metastases: A Single-Center Retrospective Study

Objective

The purpose of this study is to provide key information on the clinical characteristics, surgical treatment, and potential prognostic factors in patients with metastatic spinal gynecologic cancer (MSGC), with a view to their application in clinical practice.

Methods

From January 2010 to January 2020, we performed a retrospective analysis of 14 patients with MSGC who underwent surgical treatment in a single center. Surgical treatment was performed on 14 patients, and a total of 14 operations were performed. The survival time of patients after spinal surgery was analyzed by Kaplan–Meier and Cox regression analysis.

Results

The average age of patients was 51.9 years (range 25‒70). The average time from initial surgery to the discovery of spinal metastasis was 60.3 months (2‒180), and the average follow-up time was 19.2 months (2‒55). Spinal tumor progression was found in 9 patients, and 12 patients (85.7%) died during follow-up. In univariate analysis, extraosseous visceral metastasis (p = 0.024), revised Tokuhashi stage (p = 0.025), Tomita stage (p = 0.005), and number of spinal lesions (p = 0.038) were associated with overall survival (OS). Extraosseous visceral metastasis (p = 0.026), revised Tokuhashi stage (p = 0.014), Tomita stage (p = 0.001), and gynecological cancer type (p = 0.039) were associated with progression-free survival.

Conclusion

Surgical treatment is an effective treatment for MSGC and relieves pain, restores function and rebuilds stability. Based on our single-center experience, extraosseous visceral metastasis, revised Tokuhashi stage, Tomita stage, and gynecological cancer type may be potential prognostic factors for OS.

Metastatic spinal cord compression: review of the evidence for a radiotherapy dose fractionation schedule

Metastatic spinal cord compression is a frequent medical emergency, and the most common treatment offered is radiotherapy. The routine treatment prescription for spinal cord compression in the UK is 20 Gy in five daily fractions delivered over 1 week. Here, we evaluate the evidence base for the radiotherapy dose for spinal cord compression. Evidence from the four prospective studies conducted so far and retrospective studies does not support a uniform dose of 20 Gy for all patients with spinal cord compression. Available evidence suggests that the radiotherapy dose should be tailored to the individual patient, depending on the subtype of the tumour, the extent of metastatic disease and expected survival. A risk stratification for the optimum dose prescription for patients with spinal cord compression is recommended.

Prognostic significance of stathmin expression in correlation with metastasis and clinicopathological characteristics in human ovarian carcinoma

Stathmin, also called oncoprotein 18, is a founding member of the family of microtubule-destabilizing proteins that play a critical role in the regulation of mitosis. Stathmin is non-expressed in normal tissues, but stathmin gene is expressed at high levels in many human malignancies and the relationships between the levels of this gene expression in tumors and prognosis of the patients have been addressed. In this report, we explored the relationships between stathmin mRNA expression in ovarian carcinoma tissues and clinicopathological parameters. We collected and analyzed paraffin wax-embedded ovarian tumor biopsy tissues from 42 ovarian cancer patients in our hospital. We employed RT-PCR method and performed a densitometric analysis to determine the ratio of stathmin relative to beta-actin as an internal marker. Results showed that the stathmin mRNA expression was detected in all the ovarian carcinoma tissue samples and those samples with metastasis had higher levels of stathmin mRNA expression in initial biopsy specimens (P<0.05). Moreover, the levels of stathmin mRNA expression between samples with and without metastasis showed a statistically significant difference (P<0.05).