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MSCC — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesMSCCSCE Medical Oncology

A 50-year-old man presents with severe back pain and bilateral leg weakness (MRC grade 3/5) that has been progressive over 48 hours. He has known metastatic prostate cancer with bone metastases. MRI confirms metastatic spinal cord compression at T9. He is able to walk with assistance. What is the best definitive treatment approach?

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Correct answer: C — Emergency surgical decompression followed by radiotherapy

For MSCC in patients who are ambulatory (or recently ambulatory) with a single-level compression and reasonable expected survival, emergency posterior decompressive surgery followed by postoperative radiotherapy provides the best functional outcome. The Patchell et al trial demonstrated that surgery + RT was superior to RT alone in maintaining/restoring ambulation. NICE CG75 recommends surgery be considered within 24 hours if appropriate. Dexamethasone should be started immediately (before imaging if high clinical suspicion).

Reference: NICE CG75 Metastatic spinal cord compression; Patchell et al Lancet 2005; ESMO Oncological Emergencies