Results of a multicenter study investigating the potential impact of the overall treatment time on outcomes of radiotherapy alone with 5x4 Gy for metastatic epidural spinal cord compression

Publication date: Available online 25 July 2016
Source:Practical Radiation Oncology
Author(s): Dirk Rades, Theo Veninga, Antonio J. Conde-Moreno, Jon Cacicedo, Michaela Metz, Barbara Šegedin, Darius Norkus, Volker Rudat, Steven E. Schild
Purpose/Objective.5x4 Gy is commonly used for metastatic epidural spinal cord compression (MESCC). It is unclear whether an overall treatment time (OTT) of five days (five consecutive fractions) results in better outcomes than an OTT of seven days (no irradiation during the weekend).Methods and Materials.A total of 111 patients who received 5x4 Gy over five consecutive days were retrospectively compared to 277 patients treated with 5x4 Gy over seven days (no irradiation during the weekend) for effect on motor function, local control (LC) 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.ResultsOn multivariate analysis regarding post-RT motor function, primary tumor type (p=0.011) and time developing motor weakness (p<0.001) were significant, whereas the OTT did not even achieve significance on univariate analysis (p=0.99). On multivariate analysis of LC, visceral metastases (p=0.006) were significant. Again, the OTT was not even significant on univariate analysis (p=0.81). On multivariate analysis of OS, interval tumor diagnosis to MESCC (p=0.015), visceral metastases (p<0.001), tumor type (p=0.003), walking ability (p<0.001) and ECOG performance score (p<0.001) achieved significance. Even on univariate analysis, OTT did not have an effect on OS (p=0.79).ConclusionsLonger OTT did not impair outcomes of irradiation with 5x4 Gy for MESCC. Thus, no compensation (for example an additional radiation fraction) is necessary if the radiation treatment is not continued during the weekend.



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