A1:
As described in the last attached page.

A2:
The initial stage is stage IV (due to lung metastases, 2003/07) but no detail information on initial T&N classification; the current recurrent stage is rT0N0M1(bone), r-stage IV (AJCC 2006, 2008/04)

A3:
no pathologic stage available now due to no prior post-surgical data (2003/07)

A4:
Oncology Diagnosis: Colon cancer (histology type unknown) s/p LAR (2003/07/21) with lung metastasis, stage IV, post chemotherapy with spinal metastases (T1-2-3-4), with spinal cord compression (2008/04, T2-3), rT0N0M1(bone), r-stage IV (AJCC 2006, 2008/04)

A5:
Suggest:
(1). performed the planned spinal surgery first
(2). planned post-op RT 2 weeks later following the spinal surgery.

A6:
RT Plan may be designed as the following one:
(1). Indication: colon cancer with spinal cord/thecal sac compression
(2). Goal: palliative; consolidated treatment effect of spinal surgery.
(3). Target & Volume: C7-T1-2-3-4-5, with adequate margin
(4). Technique: 2DRT
(5). Dose & Fractionation: 3060-4500 cGy in 17-25 fractions.

A7:
In this case and other similar cases that presented with acute-onset neurologic symptoms induced by spinal cord/thecal sac compression, planned spinal surgery first with relieving compression is effective for symptoms alleviation and recovery. Post-surgery radiotherapy to the surgical bed with adequate margin is a adjuvant therapy for consolidating surgery effect.

Further Readings & References: NCCN 2008 & AJCC 2006

Radiation Oncologist
Hon-Yi Lin 2008/09/08

Fig. 1. Spinal MRI

T2 bone metastasis with posterior extension with compression on thecal sac/spinal cord (as the white arrow).

Fig. 2. Panel A. Bone Scan

increasing bone uptake over the T1-T2-T3-T4, compatible with bone metastases (as the white arrows).

Fig. 2. Panel B. SPECT scan

increasing isotope uptake over the T2-T3 bone metastatic location (as the white arrow).