title: Single-Fraction Versus 5-Fraction Radiation Therapy for Metastatic Epidural Spinal Cord Compression in Patients With Limited Survival Prognoses: Results of a Matched-Pair Analysis.
abstract: OBJECTIVE
  This study compared single-fraction to multi-fraction short-course radiation therapy (RT) for symptomatic metastatic epidural spinal cord compression (MESCC) in patients with limited survival prognosis.
  
  
  METHODS
  A total of 121 patients who received 8 Gy × 1 fraction were matched (1:1) to 121 patients treated with 4 Gy × 5 fractions for 10 factors including age, sex, performance status, primary tumor type, number of involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MESCC, pre-RT ambulatory status, and time developing motor deficits prior to RT. Endpoints included in-field repeated RT (reRT) for MESCC, overall survival (OS), and impact of RT on motor function. Univariate analyses were performed with the Kaplan-Meier method and log-rank test for in-field reRT for MESCC and OS and with the ordered-logit model for effect of RT on motor function.
  
  
  RESULTS
  Doses of 8 Gy × 1 fraction and 4 Gy × 5 fractions were not significantly different with respect to the need for in-field reRT for MESCC (P=.11) at 6 months (18% vs 9%, respectively) and 12 months (30% vs 22%, respectively). The RT regimen also had no significant impact on OS (P=.65) and post-RT motor function (P=.21). OS rates at 6 and 12 months were 24% and 9%, respectively, after 8 Gy × 1 fraction versus 25% and 13%, respectively, after 4 Gy × 5 fractions. Improvement of motor function was observed in 17% of patients after 8 Gy × 1 fraction and 23% after 4 Gy × 5 fractions, respectively.
  
  
  CONCLUSIONS
  There were no significant differences with respect to need for in-field reRT for MESCC, OS, and motor function by dose fractionation regimen. Thus, 8 Gy × 1 fraction may be a reasonable option for patients with survival prognosis of a few months.
authors.affiliation: Department of Radiation Oncology, University Hospital Lubeck, Lubeck, Germany. Electronic address: Rades.Dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Department of Radiation Oncology, University Hospital Lubeck, Lubeck, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Huttenlocher
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Šegedin
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Ana
authors.initials: A
authors.lastname: Perpar
authors.affiliation: Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Conde
authors.affiliation: Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Garcia
authors.affiliation: Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya, Spain.
authors.forename: Jon
authors.initials: J
authors.lastname: Cacicedo
authors.affiliation: Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, Saudi Arabia.
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D019583:Dose Fractionation, Radiation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008017:Life Expectancy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011379:Prognosis; D011879:Radiotherapy Dosage; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D013997:Time Factors