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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

Purpose: 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 and Materials: 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% andmore » 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.« less
Authors:
 [1] ;  [1] ; ;  [2] ; ;  [3] ;  [4] ;  [5] ;  [6] ;  [7] ;  [8]
  1. Department of Radiation Oncology, University Hospital Lubeck, Lubeck (Germany)
  2. Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana (Slovenia)
  3. Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón (Spain)
  4. Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg (Netherlands)
  5. Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands)
  6. Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya (Spain)
  7. Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar (Saudi Arabia)
  8. Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona (United States)
Publication Date:
OSTI Identifier:
22458784
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 93; Journal Issue: 2; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPARATIVE EVALUATIONS; COMPRESSION; DIAGNOSIS; FRACTIONATED IRRADIATION; METASTASES; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SPINAL CORD; VERTEBRAE