Abstract
Background: Malignant psoas syndrome (MPS) is a rare and underreported clinical syndrome that significantly impacts the quality of life of cancer patients through its metastatic infiltration of the iliopsoas muscle. Patients suffering from MPS often present with painful hip flexion, loss of mobility, and immense pain in the legs and back. The current literature describing the diagnostic criteria, management, and prognosis of MPS is limited primarily to case reports and outdated literature reviews. There remains a gap in the current knowledge of MPS and in the management of this complex cancer-related pain syndrome. Thus, a scoping review was necessary to synthesize the available clinical evidence from case reports and case series.
Objective: This scoping review aimed to map current case reports and case series on MPS for diagnostic criteria, treatment modalities, and resulting prognoses of MPS in late-stage cancer patients.
Method: A systematic search using the databases EMBASE and PubMed was conducted to access case reports and case series published between January 1990 and October 2022 that met the study’s inclusion criteria: 1) adult patients with metastatic cancer; 2) MPS symptoms secondary to infiltration of iliopsoas; 3) diagnostic criteria, treatment modality and prognosis; and 4) English-language text. Our search strategy yielded 1926 citations. After removing 629 duplicates, 1,284 reports were excluded due to failure to meet eligibility criteria (n=1,272) or inaccessibility (n=12). Using the JBI appraisal tools for case reports and case series, a total of 13 articles remained for inclusion and analysis in this scoping review.
Results: With histories of either genitourinary, hepatic, gastric, or skin cancer, each case reported new onset intense pain in the legs, back, abdomen, or pelvis with associated symptoms such as flexion of the hip or gait disorder. CT, MRI, or PET typically confirmed metastasis into the iliopsoas causing these symptoms which suggested MPS. Each case utilized two to six different pain management strategies to alleviate MPS symptoms. Many cases first used opioids for pain relief. Following a necessitated increase in morphine equivalent daily dose, a subsequent increase in strength of analgesic, change in route of administration, and integration of combination drug therapy were generally added to the treatment regime. Many cases reported successful management of symptoms through utilizing methadone, radiation therapy, botulinum toxin injection, increased opioid dosage, or epidural catheter administration of opioid.
Conclusion: A unified clinical definition of MPS may be required to inform physicians of this syndrome to help support clinical decisions regarding treatments for patients. The studies indicated that a clearer guideline for treatment protocol may be warranted as most cases reported utilizing various treatment medication dosages and procedures with vastly differing results.
