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MSCC Surgical Indication — RACP Adult Medicine MCQ

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ModerateMedical OncologyMSCC Surgical IndicationRACP Adult Medicine

A 55-year-old woman with known breast cancer presents with acute onset back pain and bilateral leg weakness progressing over 12 hours. MRI shows epidural metastatic disease at T7 causing cord compression. She has a single level of compression and is still ambulatory. What is the optimal definitive treatment?

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Correct answer: E — Surgical decompression followed by radiotherapy

For metastatic spinal cord compression (MSCC) in patients who are ambulatory with a single level of compression and a life expectancy >3 months, surgical decompression (laminectomy with or without stabilisation) followed by post-operative radiotherapy provides superior outcomes compared to radiotherapy alone (Patchell trial – 84% vs 57% ambulatory post-treatment). High-dose dexamethasone (16 mg IV stat then 4 mg QID) should be commenced immediately. Ambulatory status at time of treatment is the strongest predictor of post-treatment mobility.

Reference: Cancer Council Australia – 2020 – MSCC Guidelines; NICE – 2023 – MSCC Guidelines