Radiation therapy in metastatic compression of the spinal cord : results of 8Gy x 2 fractions

Abstract EN

Purpose : our aim was to evaluate the clinical outcome and toxicity of a short course of radiation therapy in selected patients with metastatic spinal cord compression.

Patients and methods : between September 1997 and December 1998, 35 patients with metastatic spinal cord compression from low radio-responsive primary tumors (non-small cell lung, kidney, bladder and gastrointestinal carcinomas and soft tissue sarcomas), or more radio-responsive ones (breast and prostate carcinomas, myeloma and non-Hodgkin's lymphoma) with paresis, plegia, low performance status (PS ECOG ≥ 3) and / or short life expectancy, underwent short-course of radiation therapy ; a single fraction of 8 Gy repeated after 1 week in responders or patients with stable disease for a total of 16 Gy.

Out of 35 evaluable patients, 3 (8.6 %) underwent simple laminecto-my and radiotherapy and the other 32 received radiotherapy alone.

Median follow up was 20 months (range, 7-32).

Response was assessed according to the severity of back pain and motor function and bladder capacity before and after radiotherapy.

Results : pain relief was achieved in 82.9% of patients and motor function response rate reached 71.4 %.

Early diagnosis and therapy were very important in predicting response to radiotherapy.

All but 2 (90 %) pretreatment walking patients and all but 1 (96.4 %) with good bladder function preserved these capacities.

On the contrary, when diagnosis was late, only 46.7 % of non-ambulatory patients and 42.9 % of those with bladder dysfunction improved.

Median survival was 6 months, with a 32 % probability of survival for 1 year.

Length of survival was significantly longer in patients with the ability to walk before and / or after radiotherapy.

The survival and duration of response was significantly associated with each other with no evidence of relapse in the irradiated area.

Sickness appeared only in a few cases.

Slight esophagitis was more frequent, dysphagia for solid foods was observed in 25 % of patients irradiated thoracic vertebrae.

Late toxicity was not observed.

Conclusion : The use of a single fraction of 8 Gy repeated after 1 week for a total of 16 Gy gave a clinical outcome comparable with that expected from more protracted regimens with only slight side effects.

The use of a few large treatment fractions could be explored considering the associated advantages for the patients and radiation therapy centers often overloaded by long patient waiting lists.