title: Results of a multicenter study investigating the potential impact of the overall treatment time on outcomes of radiation therapy alone with 5×4 Gy for metastatic epidural spinal cord compression.
abstract: OBJECTIVE
  A 5×4 Gy program is commonly used for metastatic epidural spinal cord compression (MESCC). It is unclear whether an overall treatment time (OTT) of 5 days (5 consecutive fractions) results in better outcomes than an OTT of 7 days (ie, no irradiation during the weekend).
  
  
  METHODS
  A total of 111 patients who received 5×4 Gy over 5 consecutive days were retrospectively compared with 277 patients treated with 5×4 Gy over 7 days (no irradiation during the weekend) for effect on motor function, local control of MESCC, and overall survival (OS). Ten further characteristics were evaluated: age, gender, interval tumor diagnosis to MESCC, visceral metastases, other bone metastases, primary tumor type, time developing motor deficits, walking ability, vertebrae involved, and performance status.
  
  
  RESULTS
  On multivariate analysis regarding post-radiation therapy motor function, primary tumor type (P = .011) and time developing motor weakness (P < .001) were significant, whereas the OTT did not even achieve significance on univariate analysis (P = .99). On multivariate analysis of local control, visceral metastases (P = .006) were significant. Again, the OTT was not even significant on univariate analysis (P = .81). On multivariate analysis of OS, interval tumor diagnosis to MESCC (P = .015), visceral metastases (P .001), tumor type (P = .003), walking ability (P < .001), and Eastern Cooperative Oncology Group performance score (P < .001) achieved significance. Even on univariate analysis, OTT did not have an effect on OS (P = .79).
  
  
  CONCLUSIONS
  Longer OTT did not impair outcomes of irradiation with 5×4 Gy for MESCC; thus, no compensation (for example an additional radiation fraction) is necessary if the radiation treatment is not continued during the weekend.
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. Electronic address: Rades.Dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.affiliation: Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Conde-Moreno
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, University of Würzburg, Würzburg, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Metz
authors.affiliation: Department of Radiation Oncology, University of Vilnius, Vilnius, Lithuania.
authors.forename: Barbara
authors.initials: B
authors.lastname: Šegedin
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Darius
authors.initials: D
authors.lastname: Norkus
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; D019583:Dose Fractionation, Radiation; D015174:Epidural Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068079:Motor Disorders / Q000175:diagnosis / Q000209:etiology; D015999:Multivariate Analysis; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000532:radiotherapy*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking