Dose Escalation for Metastatic Spinal Cord Compression in Patients With Relatively Radioresistant Tumors

Journal Article · Mon Aug 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.04.026· OSTI ID:21587635

Rades, Dirk ^[1]; Freundt, Katja; Meyners, Thekla ^[1]; Bajrovic, Amira ^[2]; Basic, Hiba ^[3]; Karstens, Johann H ^[4]; Adamietz, Irenaeus A ^[5]; Wildfang, Ingeborg ^[6]; Rudat, Volker ^[7]; Schild, Steven E ^[8]; Dunst, Juergen ^[1]

---

1. Department of Radiation Oncology, University of Lubeck (Germany)
2. Department of Radiation Oncology, University of Hamburg (Germany)
3. Department of Radiation Oncology, University of Sarajevo (Bosnia and Herzegowina)
4. Department of Radiation Oncology, Medical School Hannover (Germany)
5. Department of Radiation Oncology, Ruhr University Bochum (Germany)
6. Department of Radiation Oncology, Siloah Hospital Hannover (Germany)
7. Department of Radiation Oncology, Saad Specialist Hospital Al-Khobar (Saudi Arabia)
8. Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ (United States)

Purpose: 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 and Materials: 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.

• OSTI ID: 21587635
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 80; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
CARCINOMAS
CENTRAL NERVOUS SYSTEM
DIAGNOSIS
DISEASES
DOSES
EPITHELIOMAS
KIDNEYS
MATHEMATICS
MEDICINE
MELANOMAS
METASTASES
MULTIVARIATE ANALYSIS
NEOPLASMS
NERVOUS SYSTEM
NUCLEAR MEDICINE
ORGANS
RADIATION DOSES
RADIOLOGY
RADIOTHERAPY
SKELETON
SPINAL CORD
STATISTICS
THERAPY
VERTEBRAE