title: A royal college of radiologists national audit of radiotherapy in the treatment of metastatic spinal cord compression and implications for the development of acute oncology services.
abstract: OBJECTIVE
  To audit the current use of radiotherapy in UK cancer centres for the treatment of metastatic spinal cord compression against national standards that seek to optimise functional and quality of life outcomes.
  
  
  METHODS
  A Royal College of Radiologists prospective national audit of patients treated with radiotherapy in UK cancer centres was carried out over a 3 month period between September and December 2008, with a repeat audit carried out in August 2012.
  
  
  RESULTS
  Five hundred and ninety-six cases were received from 42 cancer centres (74%) in 2008, with data from 323 cases received from 52 (90%) centres in 2012. Ninety-three per cent (358) of patients had a diagnostic magnetic resonance imaging scan carried out within 24 h of referral for radiotherapy in 2008 compared with 205 patients (97%) in 2012. One hundred and eleven (32%) good prognosis patients were discussed with spinal surgeons; only 10 good prognosis patients were recorded as proceeding to surgery in 2008. This improved in 2012, with 94 (41% of good prognosis patients recorded as having been discussed with nine proceeding to surgery). Sixty-nine per cent of paraplegic patients in 2008 received multiple fractions of radiotherapy, which was similar to 2012 when 62% received more than a single fraction. A metastatic spinal cord compression co-ordinator was available in just over 50% of cases (164/323) and was involved in patient management in 26% of cases in 2012.
  
  
  CONCLUSIONS
  Despite level 1 evidence of the superior functional outcome and survival benefit for surgery, few good prognosis patients were recorded as having been discussed with surgeons and even fewer proceeded to surgery.
authors.affiliation: Belfast Health and Social Care Trust, Trust Headquarters, Belfast City Hospital, Belfast, UK. Electronic address: ursulamcgivern@doctors.org.uk.
authors.forename: U M
authors.initials: UM
authors.lastname: McGivern
authors.affiliation: The Royal College of Radiologists, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Drinkwater
authors.affiliation: Belfast Health and Social Care Trust, Trust Headquarters, Belfast City Hospital, Belfast, UK.
authors.forename: J I M
authors.initials: JI
authors.lastname: Clarke
authors.affiliation: The Royal Marsden, Sutton, Surrey, UK.
authors.forename: I
authors.initials: I
authors.lastname: Locke
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D009362:Neoplasm Metastasis; D010819:Physician's Role; D011446:Prospective Studies; D018787:Radiation Oncology / Q000379:methods / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000706:statistics & numerical data; D013117:Spinal Cord Compression / Q000209:etiology / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000556:secondary*; D006113:United Kingdom
keywords: MSCC; Metastatic spinal cord compression; radiotherapy