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      A matched-pair analysis comparing 5x4 Gy and 10x3 Gy for metastatic spinal cord compression (MSCC) in patients with favorable survival prognoses

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          Abstract

          Background

          It is currently not possible to get an approval of our ethics committee for a randomized trial cmparing 5x4 Gy and 10x3 Gy for MSCC that includes patients with favorable survival prognoses. Therefore, this matched-pair study following strict matching criteria was perfomed instead.

          Methods

          In this study, 142 receiving 5x4 Gy were retrospectively matched (1:1) to 142 patients receiving 10x3 Gy with respect to ten characteristics. These characteristics included age, gender, performance status, tumor type, involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MSCC, pre-RT ambulatory status, and time developing motor deficits.

          Results

          On multivariate analysis, post-RT motor function was associated with performance status (p < 0.001), tumor type (p < 0.001), and time developing motor deficits (p < 0.001). RT was successful in 76% of patients receiving 5x4 Gy and 69% receiving 10x3 Gy (p = 0.14). Pre.RT ambulatory status showed a strong trend with respect to local control (LC) of MSCC in the multivariate analysis (p = 0.058). 1-year LC rates were 87% after 5x4 Gy and 93% after 10x3 Gy (p = 0.16). On multivariate analysis, survival (OS) was associated with performance score (p < 0.001), visceral metastases (p < 0.001), and pre-RT ambulatory status (p = 0.004). 1-year OS rates were 68% after 5x4 Gy and 73% after 10x3 Gy (p = 0.64).

          Conclusions

          In patients irradiated for MSCC who had favorable survival prognoses, post-RT motor function, LC and OS were not significantly different after 5x4 Gy and after 10x3 Gy.

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          Most cited references16

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          Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression.

          P Hoskin, Philip Poortmans, Theo Veninga … (2005)
          To study five radiotherapy (RT) schedules and potential prognostic factors for functional outcome in metastatic spinal cord compression (MSCC). One thousand three hundred four patients who were irradiated from January 1992 to December 2003 were included in this retrospective review. The schedules of 1 x 8 Gy in 1 day (n = 261), 5 x 4 Gy in 1 week (n = 279), 10 x 3 Gy in 2 weeks (n = 274), 15 x 2.5 Gy in 3 weeks (n = 233), and 20 x 2 Gy in 4 weeks (n = 257) were compared for motor function, ambulatory status, and in-field recurrences. The following potential prognostic factors were investigated: age, sex, performance status, histology, number of involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits before RT. A multivariate analysis was performed with the ordered logit model. Motor function improved in 26% (1 x 8 Gy), 28% (5 x 4 Gy), 27% (10 x 3 Gy), 31% (15 x 2.5 Gy), and 28% (20 x 2 Gy); and posttreatment ambulatory rates were 69%, 68%, 63%, 66%, and 74% (P = .578), respectively. On multivariate analysis, age, performance status, primary tumor, involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits were significantly associated with functional outcome, whereas the RT schedule was not. Acute toxicity was mild, and late toxicity was not observed. In-field recurrence rates at 2 years were 24% (1 x 8 Gy), 26% (5 x 4 Gy), 14% (10 x 3 Gy), 9% (15 x 2.5 Gy), and 7% (20 x 2 Gy) (P < .001). Neither the difference between 1 x 8 Gy and 5 x 4 Gy (P = .44) nor between 10 x 3 Gy, 15 x 2.5 Gy, and 20 x 2 Gy (P = .71) was significant. The five RT schedules provided similar functional outcome. The three more protracted schedules seemed to result in fewer in-field recurrences. To minimize treatment time, the following two schedules are recommended: 1 x 8 Gy for patients with poor predicted survival and 10 x 3 Gy for other patients. Results should be confirmed in a prospective randomized trial.
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            Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression.

            Johann Karstens, Juergen Dunst, R Schulte … (2006)
            To evaluate potential prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression (MSCC). The following potential prognostic factors were investigated retrospectively in 1,852 patients irradiated for MSCC: age, sex, performance status, primary tumor, interval between tumor diagnosis and MSCC ( 15 months), number of involved vertebrae (one to two v > or = three), other bone metastases, visceral metastases, pretreatment ambulatory status, time of developing motor deficits before radiotherapy (faster, 1 to 14 v slower, > 14 days), and radiation schedule (short-course v long-course radiotherapy). On univariate analysis, improved local control of MSCC was associated significantly with favorable histology (breast cancer, prostate cancer, lymphoma/myeloma), no visceral metastases, and long-course radiotherapy. On multivariate analysis, absence of visceral metastases and radiation schedule maintained significance. On univariate analysis, improved survival was associated significantly with female sex, favorable histology, no visceral or other bone metastases, good performance status, being ambulatory before radiotherapy, longer interval between tumor diagnosis and MSCC, and slower development of motor deficits before radiotherapy. Long-course radiotherapy showed a trend. On multivariate analysis, histology, visceral metastases, other bone metastases, ambulatory status before radiotherapy, interval between tumor diagnosis and MSCC, and time of developing motor deficits maintained significance. Poorer local control after radiotherapy for MSCC is associated with visceral metastases and short-course radiotherapy. Long-course radiotherapy seems preferable for patients with more favorable prognoses, given that these patients may live long enough to develop MSCC recurrences. Long-term survival after radiotherapy for MSCC may be predicted if several prognostic factors are considered.
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              Malignant spinal-cord compression.

              Dheerendra Prasad, David Schiff (2004)
              Malignant spinal-cord compression (MSCC) is a common complication of cancer and has a substantial negative effect on quality of life and survival. Despite widespread availability of good diagnostic technology, studies indicate that most patients are diagnosed only after they become unable to walk. We review the epidemiology, pathophysiology, and clinical features of MSCC. Clinical trials have informed the optimum management of MSCC, and we review the role of corticosteroids, radiotherapy, and surgery in the management of patients. We also emphasise advances in radiation delivery and the results of a randomised trial that supported aggressive debulking in patients with MSCC.
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                Author and article information

                Contributors
                Dirk Rades: rades.dirk@gmx.net
                Stefan Huttenlocher: stefan.huttenlocher@uksh.de
                Theo Veninga: veninga.t@bvi.nl
                Amira Bajrovic: bajrovic@uke.uni-hamburg.de
                Michael Bremer: Bremer.Michael@mh-hannover.de
                Volker Rudat: vrudat@saamedical.com
                Steven E Schild: sschild@mayo.edu
                Journal
                Journal ID (nlm-ta): Radiat Oncol
                Journal ID (iso-abbrev): Radiat Oncol
                Title: Radiation Oncology (London, England)
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1748-717X
                Publication date (Electronic): 15 April 2015
                Publication date PMC-release: 15 April 2015
                Publication date Collection: 2015
                Volume: 10
                Electronic Location Identifier: 90
                Affiliations
                [ ]Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
                [ ]Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands
                [ ]Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany
                [ ]Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
                [ ]Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, Saudi Arabia
                [ ]Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ USA
                Article
                Publisher ID: 403
                DOI: 10.1186/s13014-015-0403-y
                PMC ID: 4399398
                SO-VID: b2a9a55e-e7bb-43d2-82a7-47652a371db6
                Copyright © © Rades et al.; licensee BioMed Central. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 25 February 2015
                Date accepted : 8 April 2015
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: metastatic spinal cord compression,irradiation,favorable survival prognoses,fractionation schedules,treatment outcomes
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: metastatic spinal cord compression, irradiation, favorable survival prognoses, fractionation schedules, treatment outcomes

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