Comparison of Short-Course Radiotherapy Versus Long-Course Radiotherapy for Treatment of Metastatic Spinal Cord Compression

Radiotherapy (RT) alone is the most frequently applied treatment modality for metastatic spinal cord compression (MSCC). Short-course RT (overall treatment time one week or less) provides a similar functional outcome to longer programmes. Therefore, short-course RT should be seriously considered for many MSCC patients, especially for those with a poor survival prognosis. By contrast, a considerable proportion of MSCC patients live long enough to experience a local recurrence of MSCC in the previously irradiated area of the spinal cord. Long-course RT (30–40Gy in two to four weeks) results in significantly better local control than short-course RT and should therefore be administered to patients with a more favourable survival prognosis. Survival can be estimated with a newly developed scoring system. If re-irradiation is required, a second course of RT can be safely administered in most cases after primary short-course RT. After primary long-course RT, re-irradiation should optimally be performed with high-precision techniques in order to reduce the risk of radiation-related myelopathy.

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Short-Course Radiotherapy for Metastatic Spinal Cord Compression in Lung Cancer Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2005.07.266 ◽

2005 ◽

Vol 63 ◽

pp. S155

Author(s):

D. Rades ◽

L.J. Stalpers ◽

T. Veninga ◽

R. Schulte ◽

P.J. Hoskin

Keyword(s):

Lung Cancer ◽

Spinal Cord ◽

Cancer Patients ◽

Spinal Cord Compression ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Lung Cancer Patients ◽

Short Course ◽

Short Course Radiotherapy

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Final Results of a Prospective Study Comparing the Local Control of Short-Course and Long-Course Radiotherapy for Metastatic Spinal Cord Compression

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.10.073 ◽

2011 ◽

Vol 79 (2) ◽

pp. 524-530 ◽

Cited By ~ 113

Author(s):

Dirk Rades ◽

Marisa Lange ◽

Theo Veninga ◽

Lukas J.A. Stalpers ◽

Amira Bajrovic ◽

...

Keyword(s):

Spinal Cord ◽

Prospective Study ◽

Local Control ◽

Spinal Cord Compression ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Short Course ◽

Long Course ◽

A Prospective Study

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Preliminary Results of Spinal Cord Compression Recurrence Evaluation (Score-1) Study Comparing Short-Course Versus Long-Course Radiotherapy for Local Control of Malignant Epidural Spinal Cord Compression

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2008.04.044 ◽

2009 ◽

Vol 73 (1) ◽

pp. 228-234 ◽

Cited By ~ 77

Author(s):

Dirk Rades ◽

Marisa Lange ◽

Theo Veninga ◽

Volker Rudat ◽

Amira Bajrovic ◽

...

Keyword(s):

Spinal Cord ◽

Local Control ◽

Spinal Cord Compression ◽

Cord Compression ◽

Preliminary Results ◽

Evaluation Score ◽

Short Course ◽

Long Course

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Short-Course Versus Split-Course Radiotherapy in Metastatic Spinal Cord Compression: Results of a Phase III, Randomized, Multicenter Trial

Journal of Clinical Oncology ◽

10.1200/jco.2005.08.193 ◽

2005 ◽

Vol 23 (15) ◽

pp. 3358-3365 ◽

Cited By ~ 232

Author(s):

Ernesto Maranzano ◽

Rita Bellavita ◽

Romina Rossi ◽

Verena De Angelis ◽

Alessandro Frattegiani ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Response Duration ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Phase Iii ◽

Bladder Function ◽

Short Course ◽

Significant Difference ◽

Grade 3

Purpose Hypofractionated radiotherapy (RT) is often used in the treatment of metastatic spinal cord compression (MSCC). This randomized trial was planned to assess the clinical outcome and toxicity of two different hypofractionated RT regimens in MSCC. Patients and Methods Three hundred patients with MSCC were randomly assigned to a short-course RT (8 Gy × 2 days) or to a split-course RT (5 Gy × 3; 3 Gy × 5). Only patients with a short life expectancy entered the protocol. Median follow-up was 33 months (range, 4 to 61 months). Results A total of 276 (92%) patients were assessable; 142 (51%) treated with the short-course and 134 (49%) treated with the split-course RT regimen. There was no significant difference in response, duration of response, survival, or toxicity found between the two arms. When short- versus split-course regimens were compared, after RT 56% and 59% patients had back pain relief, 68% and 71% were able to walk, and 90% and 89% had good bladder function, respectively. Median survival was 4 months and median duration of improvement was 3.5 months for both arms. Toxicity was equally distributed between the two arms: grade 3 esophagitis or pharyngitis was registered in four patients (1.5%), grade 3 diarrhea occurred in four patients (1.5%), and grade 3 vomiting or nausea occurred in 10 patients (6%). Late toxicity was never recorded. Conclusion Both hypofractionated RT schedules adopted were effective and had acceptable toxicity. However, considering the advantages of the short-course regimen in terms of patient convenience and machine time, it could become the RT regimen of choice in the clinical practice for MSCC patients.

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Short-course radiotherapy is not optimal for spinal cord compression due to myeloma

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2005.10.018 ◽

2006 ◽

Vol 64 (5) ◽

pp. 1452-1457 ◽

Cited By ~ 45

Author(s):

Dirk Rades ◽

Peter J. Hoskin ◽

Lukas J.A. Stalpers ◽

Rainer Schulte ◽

Philip Poortmans ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Short Course ◽

Short Course Radiotherapy

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Radiotherapy is effective for metastatic spinal cord compression in patients with epithelial ovarian cancer

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2006.00765.x ◽

2007 ◽

Vol 17 (1) ◽

pp. 263-265 ◽

Cited By ~ 6

Author(s):

D. Rades ◽

S. E. Schild ◽

J. Dunst

Keyword(s):

Ovarian Cancer ◽

Spinal Cord ◽

Epithelial Ovarian Cancer ◽

Cancer Patients ◽

Motor Function ◽

Cord Compression ◽

Short Course ◽

Radiotherapy Alone ◽

Long Course ◽

Short Course Radiotherapy

Ovarian cancer patients developing metastatic spinal cord compression (MSCC) are extremely rare and account for only 0.4% of MSCC patients. Only very few case reports are available in the literature. This analysis evaluates seven ovarian cancer patients treated for MSCC with radiotherapy alone. Data of 1,852 MSCC patients irradiated between 1992 and 2005 were retrospectively reviewed. Seven patients were identified with epithelial ovarian cancer. These seven patients were evaluated for functional outcome, ambulatory status, local control of MSCC, and survival. The patients received either short-course radiotherapy (1 × 8 Gy or 5 × 4 Gy, n= 2) or long-course radiotherapy (10 × 3 Gy, 15 × 2.5 Gy, or 20 × 2 Gy, n= 5). Improvement of motor function occurred in three of the seven patients, in three of the five patients after long-course radiotherapy, and none of the two patients after short-course radiotherapy. Two of the five nonambulatory patients regained the ability to walk after radiotherapy. No further deterioration of motor function was seen in another three of the seven patients, in two of the five patients after long-course radiotherapy, and one of the two patients after short-course radiotherapy. Deterioration occurred in one of the seven patients, in none of the five patients after long-course radiotherapy, and one of the two patients after short-course radiotherapy. Patients died after a median interval of 4 months (range 1–7 months) following radiotherapy. A recurrence of MSCC did not occur. Radiotherapy alone is effective in improving or maintaining motor function in MSCC patients with ovarian cancer and should be administered if decompressive surgery is not indicated.

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