Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase III, randomized, multicenter trial.
OBJECTIVE
Hypofractionated radiotherapy (RT) is often used in the treatment of metastatic spinal cord compression (MSCC). This randomized trial was planned to assess the clinical outcome and toxicity of two different hypofractionated RT regimens in MSCC.


METHODS
Three hundred patients with MSCC were randomly assigned to a short-course RT (8 Gy x 2 days) or to a split-course RT (5 Gy x 3; 3 Gy x 5). Only patients with a short life expectancy entered the protocol. Median follow-up was 33 months (range, 4 to 61 months).


RESULTS
A total of 276 (92%) patients were assessable; 142 (51%) treated with the short-course and 134 (49%) treated with the split-course RT regimen. There was no significant difference in response, duration of response, survival, or toxicity found between the two arms. When short- versus split-course regimens were compared, after RT 56% and 59% patients had back pain relief, 68% and 71% were able to walk, and 90% and 89% had good bladder function, respectively. Median survival was 4 months and median duration of improvement was 3.5 months for both arms. Toxicity was equally distributed between the two arms: grade 3 esophagitis or pharyngitis was registered in four patients (1.5%), grade 3 diarrhea occurred in four patients (1.5%), and grade 3 vomiting or nausea occurred in 10 patients (6%). Late toxicity was never recorded.


CONCLUSIONS
Both hypofractionated RT schedules adopted were effective and had acceptable toxicity. However, considering the advantages of the short-course regimen in terms of patient convenience and machine time, it could become the RT regimen of choice in the clinical practice for MSCC patients.
Maranzano
Ernesto
E
U.O. di Radioterapia Oncologica, Azienda Ospedaliera S Maria, Via T di Joannuccio, 1, 05100 Terni, Italy. ernesto.maranzano@libero.it
Bellavita
Rita
R
Rossi
Romina
R
De Angelis
Verena
V
Frattegiani
Alessandro
A
Bagnoli
Rita
R
Mignogna
Marcello
M
Beneventi
Sara
S
Lupattelli
Marco
M
Ponticelli
Pietro
P
Biti
Gian Paolo
GP
Latini
Paolo
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D016019:Survival Analysis; D016896:Treatment Outcome