Neurological Manifestation of Spinal Metastasis of Malignant Melanoma : Clinical Analysis of 26 Patients

Abstract

Merkezi sinir sistemine slklzkla metastaz yapan tiimorlerden biri olmasma ragmen, malign melanomalann spinal metastazlan kzsmen nadirdir. Primer olarak oliimciil olmayan spinal metastazlar, hastamn ambiilasyonunda bozukluklara ve sfinkter kusurlanna neden olarak, oldukf;a slkmtllz bir tablo olu~turabilirler. Bu r;alz~mamn amacı, bu hastalzgm, norolojik tablo geli~tikten sonraki seyrini belirliyerek,radyoterapinin semptomlar ve norolojik bozukluklar iizerine etkinligini ara~tlrmaktlr. Malign melanoma'mn spinal metastazlmn, norolojik bozukluk yaptlgl 26 hasta retrospektif olarak analiz edildi. Median ya~ 48 'di(24-87 arasl). 15 hastada epidural metastaza baglz kord kompresyonu, 6 hastada intrameduller, 5 hastada leptomenenjial metastaz vardl. Bu hastalarm 17 'sinde agn ~ikayeti mevcuttu. 12 hastanm ilk ~ikayeti norolojik bozukluklar iken, 14 hastada ilk ~ikayet agnydl. Agrl ~ikayeti olup ta radyoterapi yapllan hastalarm 5'inde agn kayboldu veya azaldl, 13 'iinde degi~medi, 2 'sinde arttl. Radyoterapi yapzlan hastalann, 9'unda norolojik defisitler diizelirken, 7'sinde arttl, lO'unda degi~medi. Radyoterapinin,norolojik diizelme iizerine onemli derecede etkisi varken (p<0.03), agn iizerine herhangi bir etkisi olmadlgl saptandı.

Although malignant melanoma is one of the most common causes of central nervous system metastases, spinal metastases from it are relatively rare. Despite spinal metastases primarily are not fatal, they may be catastrophic because of ambulation loss and sphincter disturbances. The purpose of this study was to review the course of this illnes after the development of neurological deficits and to asses the efficiacy of radiation therapy on symptoms and signs of spinal metastasis. 26 patients with neurological manifestations from spinal metastasis of melanoma were analyzed retrospectively. Median age of the patients was 48 years (range 24-87). Fifteen patients had cord compression by epidural metastasis, 6 patients had intramedullary,and 5 patients had leptomenengial metastasis. 17 of these patients suffered from pain. In 12 patients, first symptom was neurological disturbance, while in 14 patients it was pain. In patients who received radiotherapy for pain, in 5 patients pain improved, in 13 patients remained unchanged, in 2 patients worsened. In patients who received radiotherapy for neurological deficits, in 9 patients deficit improved, in patients worsened, in 10 patients did not change. While radiotherapy had significant effect on neurological recovery (p<0.03), it did not have any effect on pain.