Spinal reirradiation after short-course RT for metastatic spinal cord compression.
OBJECTIVE
To investigate the feasibility and effectiveness of reirradiation (re-RT) for in-field recurrence of metastatic spinal cord compression after primary RT with 1 x 8 Gy or 5 x 4 Gy.


METHODS
A total of 62 patients, treated with 1 x 8 Gy (n = 34) or 5 x 4 Gy (n = 28) between January 1995 and August 2003, received re-RT for in-field recurrence of metastatic spinal cord compression. The median time to recurrence was 6 months (range, 2-40 months). Re-RT was performed with 1 x 8 Gy (after 1 x 8 Gy or 5 x 4 Gy, n = 34), 5 x 3 Gy (after 1 x 8 Gy or 5 x 4 Gy, n = 15), or 5 x 4 Gy (after 1 x 8 Gy, n = 13). The cumulative biologically effective dose (primary RT plus re-RT) was 80-100 Gy2. The median follow-up after re-RT was 8 months (range, 2-42 months). Motor function was evaluated up to 6 months after re-RT.


RESULTS
After re-RT, 25 patients (40%) showed improvement of motor function, 28 (45%) had no change, and 9 (15%) had deterioration. Of the 16 previously nonambulatory patients, 6 (38%) regained the ability to walk. No second in-field recurrence in the same spinal region was observed after re-RT. The outcome was not significantly influenced by the radiation schedule. Radiation myelopathy was not observed.


CONCLUSIONS
Spinal re-RT with 1 x 8 Gy, 5 x 3 Gy, or 5 x 4 Gy for in-field recurrence of metastatic spinal cord compression appears safe and effective. Myelopathy seems unlikely, if the cumulative biologically effective dose is < or = 100 Gy2.
Rades
Dirk
D
Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Rades.Dirk@gmx.net
Stalpers
Lukas J A
LJ
Veninga
Theo
T
Hoskin
Peter J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D020127:Recovery of Function; D012062:Relative Biological Effectiveness; D019233:Retreatment; D013116:Spinal Cord / Q000528:radiation effects; D013117:Spinal Cord Compression / Q000532:radiotherapy*; D013120:Spinal Cord Neoplasms / Q000532:radiotherapy* / Q000556:secondary