title: Dose escalation for metastatic spinal cord compression in patients with relatively radioresistant tumors.
abstract: OBJECTIVE
  Radiotherapy alone is the most common treatment for metastatic spinal cord compression (MSCC) from relatively radioresistant tumors such as renal cell carcinoma, colorectal cancer, and malignant melanoma. However, the results of the "standard" regimen 30 Gy/10 fractions need to be improved with respect to functional outcome. This study investigated whether a dose escalation beyond 30 Gy can improve treatment outcomes.
  
  
  METHODS
  A total of 91 patients receiving 30 Gy/10 fractions were retrospectively compared to 115 patients receiving higher doses (37.5 Gy/15 fractions, 40 Gy/20 fractions) for motor function and local control of MSCC. Ten further potential prognostic factors were evaluated: age, gender, tumor type, performance status, number of involved vertebrae, visceral or other bone metastases, interval from tumor diagnosis to radiotherapy, pretreatment ambulatory status, and time developing motor deficits before radiotherapy.
  
  
  RESULTS
  Motor function improved in 18% of patients after 30 Gy and in 22% after higher doses (p = 0.81). On multivariate analysis, functional outcome was associated with visceral metastases (p = 0.030), interval from tumor diagnosis to radiotherapy (p = 0.010), and time developing motor deficits (p < 0.001). The 1-year local control rates were 76% after 30 Gy and 80% after higher doses, respectively (p = 0.64). On multivariate analysis, local control was significantly associated with visceral metastases (p = 0.029) and number of involved vertebrae (p = 0.043).
  
  
  CONCLUSIONS
  Given the limitations of a retrospective study, escalation of the radiation dose beyond 30 Gy/10 fractions did not significantly improve motor function and local control of MSCC in patients with relatively radioresistant tumors.
authors.affiliation: Department of Radiation Oncology, University of Lubeck, Germany. Rades.Dirk@gmx.net
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Katja
authors.initials: K
authors.lastname: Freundt
authors.forename: Thekla
authors.initials: T
authors.lastname: Meyners
authors.forename: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.forename: Hiba
authors.initials: H
authors.lastname: Basic
authors.forename: Johann H
authors.initials: JH
authors.lastname: Karstens
authors.forename: Irenaeus A
authors.initials: IA
authors.lastname: Adamietz
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Wildfang
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.forename: Juergen
authors.initials: J
authors.lastname: Dunst
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D002292:Carcinoma, Renal Cell / Q000532:radiotherapy / Q000556:secondary; D015179:Colorectal Neoplasms / Q000473:pathology; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000556:secondary; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology / Q000528:radiation effects*; D010166:Palliative Care / Q000379:methods; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology; D013117:Spinal Cord Compression / Q000209:etiology / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary