Outcome After Radiotherapy Alone for Metastatic Spinal Cord Compression in Patients With Oligometastases

2007 ◽  
Vol 26 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Dirk Rades ◽  
Theo Veninga ◽  
Lukas J.A. Stalpers ◽  
Hiba Basic ◽  
Volker Rudat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Local Control ◽  
Cord Compression ◽  
Motor Deficits ◽  
Tumor Type ◽  
Ambulatory Status ◽  
Oligometastatic Disease ◽  
Radiotherapy Alone ◽  
Long Course

Purpose To investigate outcome and prognosis of metastatic spinal cord compression (MSCC) patients with oligometastatic disease treated with radiotherapy alone. Patients and Methods Oligometastatic disease was defined as involvement of three or fewer vertebrae and lack of other bone or visceral metastases. Five hundred twenty-one patients with oligometastatic disease and MSCC were evaluated for functional outcome, ambulatory status, local control of MSCC, and survival. Furthermore, seven potential prognostic factors were investigated. Results Motor function improved in 40% (n = 207), remained stable in 54% (n = 279), and deteriorated in 7% (n = 35) of patients. Fifty-eight (54%) of 107 nonambulatory patients became ambulatory, and 388 (94%) of 414 ambulatory patients remained ambulatory. Improved functional outcome was significantly associated with tumor type and slower development of motor deficits (> 14 days). Local control at 1, 2, and 3 years was 92%, 88%, and 78%, respectively. Improved local control was significantly associated with long-course radiotherapy. Survival at 1, 2, and 3 years was 71%, 58%, and 50%, respectively. Better survival was significantly associated with tumor type, ambulatory status, slower development of motor deficits, and long-course radiotherapy. Patients who developed motor deficits slowly (onset > 14 days before initiating treatment) were further analyzed. In this subgroup, the best results were observed for myeloma/lymphoma and breast cancer patients. No patient had progression of motor deficits. One hundred percent (myeloma/lymphoma) and 99% (breast cancer) of patients were ambulatory after radiotherapy. One-year local control was 100% and 98%, 1-year survival was 94% and 89%. Conclusion Given the limitations of a retrospective review, improved outcome of patients with oligometastatic MSCC was associated with myeloma/lymphoma and breast cancer, slower development of motor deficits, and a more prolonged course of radiation.

scholarly journals Comparison of 5 × 5 Gy and 10 × 3 Gy for metastatic spinal cord compression using data from three prospective trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dirk Rades ◽  
Jon Cacicedo ◽  
Antonio J. Conde-Moreno ◽  
Barbara Segedin ◽  
Darejan Lomidze ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Function ◽  
Spinal Cord Compression ◽  
Treatment Time ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Motor Deficits ◽  
Tumor Type ◽  
Ambulatory Status ◽  
Local Progression

Abstract Background In a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radiotherapy should be as short as possible. This study compared 5 × 5 Gy in 1 week to 10 × 3 Gy in 2 weeks in a prospective cohort. Methods Forty patients receiving 5 × 5 Gy in a phase II trial were matched 1:2 to 213 patients receiving 10 × 3 Gy in two previous prospective studies for tumor type, ambulatory status, time developing motor deficits, interval between tumor diagnosis and MSCC and visceral metastases. These factors were consistent in all three patients (triple) used for each 1:2 matching. Groups were compared for local progression-free survival (LPFS), motor function, ambulatory status, and overall survival (OS). Results After matching, 32 triples remained for analyses (N = 96 in total). Six-month LPFS-rates were 94% after 5 × 5 Gy and 87% after 10 × 3 Gy (p = 0.36), 6-month OS-rates 43% and 35% (p = 0.74). Improvement of motor function was achieved in 59% and 34% of patients (p = 0.028); overall response rates (improvement or no further progression of motor deficits) were 94% and 89% (p = 0.71). Post-treatment ambulatory rates were 81% after 5 × 5 Gy and 85% after 10 × 3 Gy (p = 0.61). Of non-ambulatory patients, 50% (6/12) and 46% (11/24) regained the ability to walk (p = 1.00). Conclusions 5 × 5 Gy in 1 week appeared similarly effective as 10 × 3 Gy in 2 weeks. These results may not be applicable to long-term survivors and should be confirmed in a randomized trial directly comparing 5 × 5 Gy and 10 × 3 Gy. Trial registration clinicaltrials.gov NCT03070431. Registered 27 February 2017.

Evaluation of Five Radiation Schedules and Prognostic Factors for Metastatic Spinal Cord Compression

2005 ◽  
Vol 23 (15) ◽  
pp. 3366-3375 ◽  
Author(s):  
Dirk Rades ◽  
Lukas J.A. Stalpers ◽  
Theo Veninga ◽  
Rainer Schulte ◽  
Peter J. Hoskin ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Functional Outcome ◽  
Motor Function ◽  
Cancer Diagnosis ◽  
Performance Status ◽  
Cord Compression ◽  
Motor Deficits ◽  
Ambulatory Status

Purpose To study five radiotherapy (RT) schedules and potential prognostic factors for functional outcome in metastatic spinal cord compression (MSCC). Patients and Methods 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 × 8 Gy in 1 day (n = 261), 5 × 4 Gy in 1 week (n = 279), 10 × 3 Gy in 2 weeks (n = 274), 15 × 2.5 Gy in 3 weeks (n = 233), and 20 × 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. Results Motor function improved in 26% (1 × 8 Gy), 28% (5 × 4 Gy), 27% (10 × 3 Gy), 31% (15 × 2.5 Gy), and 28% (20 × 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 × 8 Gy), 26% (5 × 4 Gy), 14% (10 × 3 Gy), 9% (15 × 2.5 Gy), and 7% (20 × 2 Gy) (P < .001). Neither the difference between 1 × 8 Gy and 5 × 4 Gy (P = .44) nor between 10 × 3 Gy, 15 × 2.5 Gy, and 20 × 2 Gy (P = .71) was significant. Conclusion 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 × 8 Gy for patients with poor predicted survival and 10 × 3 Gy for other patients. Results should be confirmed in a prospective randomized trial.

Prognostic Factors for Local Control and Survival After Radiotherapy of Metastatic Spinal Cord Compression

2006 ◽  
Vol 24 (21) ◽  
pp. 3388-3393 ◽  
Author(s):  
Dirk Rades ◽  
Fabian Fehlauer ◽  
Rainer Schulte ◽  
Theo Veninga ◽  
Lukas J.A. Stalpers ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Bone Metastases ◽  
Local Control ◽  
Performance Status ◽  
Univariate Analysis ◽  
Cord Compression ◽  
Tumor Diagnosis ◽  
Motor Deficits ◽  
Visceral Metastases ◽  
Long Course

Purpose To evaluate potential prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression (MSCC). Patients and Methods 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 v > 15 months), number of involved vertebrae (one to two v ≥ 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). Results 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. Conclusion 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.

Indications for nonoperative treatment of spinal cord compression due to breast cancer

1977 ◽  
Vol 47 (5) ◽  
pp. 653-658 ◽  
Author(s):  
Cully A. Cobb ◽  
Milam E. Leavens ◽  
Nylene Eckles
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Local Treatment ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Nonoperative Treatment ◽  
Content Type ◽  
Long Duration ◽  
Radiotherapy Alone

✓ A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological deficit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as demonstrated by neurological examination and myelography. Twenty-six of these patients were initially treated by laminectomy and 18 were initially treated with radiotherapy. The two groups did not significantly differ in their outcome with respect to motor power, pain relief, or ability to walk. Six patients who underwent radiotherapy deteriorated during 2 months of treatment. Four of these patients were not operative candidates because of poor general condition (three patients) or long duration of paraplegia (one patient). Of two patients who underwent emergency laminectomy, one became paraplegic; however, the other patient was significantly improved. For this reason it is essential that patients undergoing radiotherapy for spinal cord compression be followed closely by a neurosurgeon. The authors believe that in appropriate cases radiotherapy alone can yield results as good as laminectomy combined with radiotherapy.

Local Control of Metastatic Spinal Cord Compression Following Radiotherapy

2010 ◽  
Vol 06 (01) ◽  
pp. 24
Author(s):  
Dirk Rades ◽  
Steven E Schild ◽  
◽  
Keyword(s):  
Spinal Cord ◽  
Local Control ◽  
Spinal Cord Compression ◽  
Treatment Time ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Considerable Proportion ◽  
Survival Prognosis ◽  
Short Course ◽  
Long Course

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.

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

2007 ◽  
Vol 17 (1) ◽  
pp. 263-265 ◽  
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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