Functional outcome and survival after radiotherapy of metastatic spinal cord compression in patients with cancer of unknown primary

Journal Article · Thu Feb 01 04:00:00 EST 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.08.047· OSTI ID:20944698

Rades, Dirk ^[1]; Fehlauer, Fabian ^[2]; Veninga, Theo ^[3]; Stalpers, Lukas J.A. ^[4]; Basic, Hiba ^[5]; Hoskin, Peter J ^[6]; Rudat, Volker ^[7]; Karstens, Johann H ^[8]; Schild, Steven E ^[9]; Dunst, Juergen ^[1]

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1. Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck (Germany)
2. Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany)
3. Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg (Netherlands)
4. Department of Radiotherapy, Academic Medical Center, Amsterdam (Netherlands)
5. Department of Radiotherapy, University Hospital, Sarajevo (Bosnia and Herzegowina)
6. Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood (United Kingdom)
7. Department of Radiation Oncology, St. Josef Hospital, Ruhr University, Bochum (Germany)
8. Department of Radiation Oncology, Hannover Medical School (Germany)
9. Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona (United States)

Purpose: Patients with cancer of unknown primary (CUP) account for about 10% of patients with metastatic spinal cord compression (MSCC). This study aims to define the appropriate radiation regimen for these patients. Methods and Materials: Data of 143 CUP patients irradiated for MSCC were retrospectively evaluated. Short-course radiotherapy (RT) (1x8 Gy, 5x4 Gy, n = 68) and long-course RT (10x3 Gy, 15x2.5 Gy, 20x2 Gy, n = 75) plus 8 further potential prognostic factors (age, gender, performance status, visceral metastases, other bone metastases, number of involved vertebrae, ambulatory status, time of developing motor deficits before RT) were compared for functional outcome and survival. Results: Improvement of motor function occurred in 10% of patients, no further progression of motor deficits in 57%, and deterioration in 33%. On multivariate analysis, functional outcome was positively associated with slower development of motor deficits (p < 0.001), absence of visceral metastases (p = 0.008) and other bone metastases (p = 0.027), and ambulatory status (p = 0.054), not with the radiation regimen (p = 0.74). Recurrence of MSCC in the irradiated region occurred in 7 patients after median 6 months. Median survival was 4 months. On multivariate analysis, better survival was significantly associated with absence of visceral metastases (p < 0.001), absence of other bone metastases (p = 0.005), ambulatory status (p = 0.001), and slower development of motor deficits (p = 0.030). Conclusions: For MSCC treatment in patients with CUP, no significant difference was observed between short-course and long-course RT regarding functional outcome and survival. Short-course RT appears preferable, at least for patients with a poor predicted survival, as it is more patient convenient and more cost-effective.

• OSTI ID: 20944698
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 67; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
COMPRESSION
COST
IRRADIATION
METASTASES
MULTIVARIATE ANALYSIS
PATIENTS
RADIOTHERAPY
SPINAL CORD
VERTEBRAE