title: Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression.
abstract: OBJECTIVE
  To study five radiotherapy (RT) schedules and potential prognostic factors for functional outcome in metastatic spinal cord compression (MSCC).
  
  
  METHODS
  One thousand three hundred four patients who were irradiated from January 1992 to December 2003 were included in this retrospective review. The schedules of 1 x 8 Gy in 1 day (n = 261), 5 x 4 Gy in 1 week (n = 279), 10 x 3 Gy in 2 weeks (n = 274), 15 x 2.5 Gy in 3 weeks (n = 233), and 20 x 2 Gy in 4 weeks (n = 257) were compared for motor function, ambulatory status, and in-field recurrences. The following potential prognostic factors were investigated: age, sex, performance status, histology, number of involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits before RT. A multivariate analysis was performed with the ordered logit model.
  
  
  RESULTS
  Motor function improved in 26% (1 x 8 Gy), 28% (5 x 4 Gy), 27% (10 x 3 Gy), 31% (15 x 2.5 Gy), and 28% (20 x 2 Gy); and posttreatment ambulatory rates were 69%, 68%, 63%, 66%, and 74% (P = .578), respectively. On multivariate analysis, age, performance status, primary tumor, involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits were significantly associated with functional outcome, whereas the RT schedule was not. Acute toxicity was mild, and late toxicity was not observed. In-field recurrence rates at 2 years were 24% (1 x 8 Gy), 26% (5 x 4 Gy), 14% (10 x 3 Gy), 9% (15 x 2.5 Gy), and 7% (20 x 2 Gy) (P < .001). Neither the difference between 1 x 8 Gy and 5 x 4 Gy (P = .44) nor between 10 x 3 Gy, 15 x 2.5 Gy, and 20 x 2 Gy (P = .71) was significant.
  
  
  CONCLUSIONS
  The five RT schedules provided similar functional outcome. The three more protracted schedules seemed to result in fewer in-field recurrences. To minimize treatment time, the following two schedules are recommended: 1 x 8 Gy for patients with poor predicted survival and 10 x 3 Gy for other patients. Results should be confirmed in a prospective randomized trial.
authors.affiliation: Department of Radiation Oncology, University Hospital Hamburg, Martinistr. 52, D-20246 Hamburg, Germany. Rades.Dirk@gmx.net
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.forename: Rainer
authors.initials: R
authors.lastname: Schulte
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: Nermina
authors.initials: N
authors.lastname: Obralic
authors.forename: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schwarz
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Hulshof
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology* / Q000401:mortality / Q000532:radiotherapy*; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome