Defining the appropriate radiotherapy regimen for metastatic spinal cord compression in non-small cell lung cancer patients.

Many different schedules are used world wide for radiotherapy (RT) of metastatic spinal cord compression (MSCC). Non-small cell lung cancer (NSCLC) patients have an extraordinarily poor survival prognosis and would benefit from a short overall treatment time. This retrospective study compares short-course RT (1 x 8 Gy/1 day, 5 x 4 Gy/1 week) and long-course RT (10 x 3 Gy/2 weeks, 15 x 2.5 Gy/3 weeks, 20 x 2 Gy/4 weeks) for functional outcome in 252 NSCLC patients developing MSCC. Improvement of motor function occurred in 14% of patients, no change in 54%, and deterioration in 32%. Functional outcome was affected by the time of developing motor deficits before RT (>14 days better than 1-7 days and 8-14 days, P<0.001), not by the radiation regimen (P=0.87). In the short-course RT group, functional outcome was similar for 1 x 8 Gy and 5 x 4 Gy (P=0.94). Short-course and long-course RT appear similarly effective for MSCC in NSCLC patients. As 1 x 8 Gy and 5 x 4 Gy showed comparable results, 1 x 8 Gy can be considered appropriate.

Short-course radiotherapy is not optimal for spinal cord compression due to myeloma.

PURPOSE: To investigate the suitability of short-course radiotherapy (RT) for spinal cord compression (SCC) in myeloma patients. METHODS AND MATERIALS: Data for 172 myeloma patients irradiated between January 1994 and December 2004 for SCC were retrospectively evaluated. Short-course RT (1 x 8 Gy, 5 x 4 Gy, n = 61) and long-course RT (10 x 3 Gy, 15 x 2.5 Gy, 20 x 2 Gy, n = 111) were compared for functional outcome up to 24 months after RT. In addition, 10 potential prognostic factors were investigated. RESULTS: Improvement of motor function occurred in 90 patients (52%). Forty-seven percent of nonambulatory patients regained the ability to walk. Functional outcome was significantly influenced by the time of developing motor deficits before RT. Improvement of motor function was more frequent after long-course RT than after short-course RT: 59% vs. 39% (p = 0.10) at 1 month, 67% vs. 43% (p = 0.043) at 6 months, 76% vs. 40% (p = 0.003) at 12 months, 78% vs. 43% (p = 0.07) at 18 months, and 83% v 54% (p = 0.33) at 24 months. A subgroup analysis of the long-course RT group demonstrated a similar functional outcome for 10 x 3 Gy when compared with 15 x 2.5 Gy and 20 x 2 Gy. CONCLUSIONS: Long-course RT is preferable for SCC in myeloma patients because it resulted in better functional outcome than short-course RT. Treatment with 10 x 3 Gy can be considered appropriate.

Short-course radiotherapy (RT) for metastatic spinal cord compression (MSCC) due to renal cell carcinoma: results of a retrospective multi-center study.

OBJECTIVE: For MSCC treatment, a short treatment time is desirable, especially if survival prognosis is poor. Survival depends on the primary tumor, extent of disease, performance status, ambulatory status, and the number of involved vertebrae. These factors may help to define the appropriate regimen for the individual patient. Our study compares short-course (1 x 8 Gy, 5 x 4 Gy) and long-course RT (10 x 3 Gy, 15 x 2.5 Gy, 20 x 2 Gy) for functional outcome in MSCC patients with renal cell carcinoma. METHODS: The following potential prognostic factors for functional outcome were retrospectively investigated: age, performance status, involved vertebra, ambulatory status, time of developing motor deficits before RT, radiation schedule (short-course RT, n=37; long-course RT, n=50). RESULTS: Eighty-seven patients were included in this retrospective study, 25 patients (29%) showed improvement of motor function, 52 patients (60%) no change, 10 patients (11%) deterioration. 25% of non-ambulatory patients became ambulatory after RT. Functional outcome was affected by the time of developing motor deficits before RT (p<0.001). The RT schedule had no significant impact (p=0.91). In the short-course RT sub-group, functional outcome was similar for 1 x 8 Gy and 5 x 4 Gy (p=0.99). CONCLUSION: Short-course and long-course RT appear similarly active for MSCC in patients with renal cell carcinoma. Short-course RT appears preferable, as it is means less patient discomfort. Because 1 x 8 Gy and 5 x 4 Gy were comparably effective, 1 x 8 Gy may be suggested the best actual choice.

Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression.

PURPOSE: To evaluate potential prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression (MSCC). PATIENTS AND METHODS: The following potential prognostic factors were investigated retrospectively in 1,852 patients irradiated for MSCC: age, sex, performance status, primary tumor, interval between tumor diagnosis and MSCC (< or = 15 v > 15 months), number of involved vertebrae (one to two v > or = three), other bone metastases, visceral metastases, pretreatment ambulatory status, time of developing motor deficits before radiotherapy (faster, 1 to 14 v slower, > 14 days), and radiation schedule (short-course v long-course radiotherapy). RESULTS: On univariate analysis, improved local control of MSCC was associated significantly with favorable histology (breast cancer, prostate cancer, lymphoma/myeloma), no visceral metastases, and long-course radiotherapy. On multivariate analysis, absence of visceral metastases and radiation schedule maintained significance. On univariate analysis, improved survival was associated significantly with female sex, favorable histology, no visceral or other bone metastases, good performance status, being ambulatory before radiotherapy, longer interval between tumor diagnosis and MSCC, and slower development of motor deficits before radiotherapy. Long-course radiotherapy showed a trend. On multivariate analysis, histology, visceral metastases, other bone metastases, ambulatory status before radiotherapy, interval between tumor diagnosis and MSCC, and time of developing motor deficits maintained significance. CONCLUSION: Poorer local control after radiotherapy for MSCC is associated with visceral metastases and short-course radiotherapy. Long-course radiotherapy seems preferable for patients with more favorable prognoses, given that these patients may live long enough to develop MSCC recurrences. Long-term survival after radiotherapy for MSCC may be predicted if several prognostic factors are considered.