Dirk Rades1, Stefan Huttenlocher2, Barbara Šegedin3, Ana Perpar3, Antonio J Conde4, Raquel Garcia4, Theo Veninga5, Lukas J A Stalpers6, Jon Cacicedo7, Volker Rudat8, Steven E Schild9. 1. Department of Radiation Oncology, University Hospital Lubeck, Lubeck, Germany. Electronic address: Rades.Dirk@gmx.net. 2. Department of Radiation Oncology, University Hospital Lubeck, Lubeck, Germany. 3. Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 4. Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain. 5. Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands. 6. Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands. 7. Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya, Spain. 8. Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, Saudi Arabia. 9. Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.
Abstract
PURPOSE: This study compared single-fraction to multi-fraction short-course radiation therapy (RT) for symptomatic metastatic epidural spinal cord compression (MESCC) in patients with limited survival prognosis. METHODS AND MATERIALS: A total of 121 patients who received 8 Gy × 1 fraction were matched (1:1) to 121 patients treated with 4 Gy × 5 fractions for 10 factors including age, sex, performance status, primary tumor type, number of involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MESCC, pre-RT ambulatory status, and time developing motor deficits prior to RT. Endpoints included in-field repeated RT (reRT) for MESCC, overall survival (OS), and impact of RT on motor function. Univariate analyses were performed with the Kaplan-Meier method and log-rank test for in-field reRT for MESCC and OS and with the ordered-logit model for effect of RT on motor function. RESULTS: Doses of 8 Gy × 1 fraction and 4 Gy × 5 fractions were not significantly different with respect to the need for in-field reRT for MESCC (P=.11) at 6 months (18% vs 9%, respectively) and 12 months (30% vs 22%, respectively). The RT regimen also had no significant impact on OS (P=.65) and post-RT motor function (P=.21). OS rates at 6 and 12 months were 24% and 9%, respectively, after 8 Gy × 1 fraction versus 25% and 13%, respectively, after 4 Gy × 5 fractions. Improvement of motor function was observed in 17% of patients after 8 Gy × 1 fraction and 23% after 4 Gy × 5 fractions, respectively. CONCLUSIONS: There were no significant differences with respect to need for in-field reRT for MESCC, OS, and motor function by dose fractionation regimen. Thus, 8 Gy × 1 fraction may be a reasonable option for patients with survival prognosis of a few months.
PURPOSE: This study compared single-fraction to multi-fraction short-course radiation therapy (RT) for symptomatic metastatic epidural spinal cord compression (MESCC) in patients with limited survival prognosis. METHODS AND MATERIALS: A total of 121 patients who received 8 Gy × 1 fraction were matched (1:1) to 121 patients treated with 4 Gy × 5 fractions for 10 factors including age, sex, performance status, primary tumor type, number of involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MESCC, pre-RT ambulatory status, and time developing motor deficits prior to RT. Endpoints included in-field repeated RT (reRT) for MESCC, overall survival (OS), and impact of RT on motor function. Univariate analyses were performed with the Kaplan-Meier method and log-rank test for in-field reRT for MESCC and OS and with the ordered-logit model for effect of RT on motor function. RESULTS: Doses of 8 Gy × 1 fraction and 4 Gy × 5 fractions were not significantly different with respect to the need for in-field reRT for MESCC (P=.11) at 6 months (18% vs 9%, respectively) and 12 months (30% vs 22%, respectively). The RT regimen also had no significant impact on OS (P=.65) and post-RT motor function (P=.21). OS rates at 6 and 12 months were 24% and 9%, respectively, after 8 Gy × 1 fraction versus 25% and 13%, respectively, after 4 Gy × 5 fractions. Improvement of motor function was observed in 17% of patients after 8 Gy × 1 fraction and 23% after 4 Gy × 5 fractions, respectively. CONCLUSIONS: There were no significant differences with respect to need for in-field reRT for MESCC, OS, and motor function by dose fractionation regimen. Thus, 8 Gy × 1 fraction may be a reasonable option for patients with survival prognosis of a few months.
Authors: Dirk Rades; Antonio J Conde-Moreno; Jon Cacicedo; Theo Veninga; Barbara Segedin; Karmen Stanic; Volker Rudat; Steven E Schild Journal: Radiat Oncol Date: 2018-02-08 Impact factor: 3.481
Authors: Pierre G Thirion; Mary T Dunne; Paul J Kelly; Aileen Flavin; Joe M O'Sullivan; Dayle Hacking; Wojciech Sasiadek; Cormac Small; Maeve M Pomeroy; Joseph Martin; Orla McArdle; Imelda Parker; Lydia S O'Sullivan; Aoife M Shannon; Angela Clayton-Lea; Conor D Collins; Michael R Stevenson; Alberto Alvarez-Iglesias; John G Armstrong; Michael Moriarty Journal: Br J Cancer Date: 2020-03-11 Impact factor: 7.640