title: Radiotherapy of metastatic spinal cord compression in very elderly patients.
abstract: OBJECTIVE
  Owing to the aging of the population, the proportion of elderly patients receiving cancer treatment has increased. This study investigated the results of radiotherapy (RT) for metastatic spinal cord compression (MSCC) in the very elderly, because few data are available for these patients.
  
  
  METHODS
  The data from 308 patients aged > or =75 years who received short-course (treatment time 1-5 days) or long-course RT (2-4 weeks) for MSCC were retrospectively analyzed for functional outcome, local control, and survival. Furthermore, nine potential prognostic factors were investigated: gender, performance status, interval from tumor diagnosis to MSCC, tumor type, number of involved vertebrae, other bone or visceral metastases, ambulatory status, and speed at which motor deficits developed.
  
  
  RESULTS
  Improvement of motor deficits occurred in 25% of patients, with no further progression of MSCC in an additional 59%. The 1-year local control and survival rate was 92% and 43%, respectively. Improved functional outcomes were associated with ambulatory status and slower developing motor deficits. Improved local control resulted from long-course RT. Improved survival was associated with a longer interval from tumor diagnosis to MSCC, tumor type (breast/prostate cancer, myeloma/lymphoma), lack of visceral or other bone metastases, ambulatory status, and a slower development of motor deficits.
  
  
  CONCLUSIONS
  Short- and long-course RT are similarly effective in patients aged > or =75 years regarding functional outcome and survival. Long-course RT provided better local control. Patients with better expected survival should receive long-course RT and others short-course RT. The criteria for selection of an appropriate regimen for MSCC in very elderly patients should be the same as for younger individuals.
authors.affiliation: Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany. Rades.Dirk@gmx.net
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: Johann H
authors.initials: JH
authors.lastname: Karstens
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.forename: Juergen
authors.initials: J
authors.lastname: Dunst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D015996:Survival Rate; D016896:Treatment Outcome