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Abstract

PURPOSE:

To compare short-course radiotherapy (RT) (4 Gy × 5) to longer-course RT (3 Gy × 10) for metastatic epidural spinal cord compression (MESCC).

PATIENTS AND METHODS:

Two-hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy × 5 in 1 week (n = 101) or 3 Gy × 10 in 2 weeks (n = 102). Patients were stratified according to ambulatory status, time developing motor deficits, and primary tumor type. Seventy-eight and 77 patients, respectively, were evaluable for the primary end point, 1-month overall response regarding motor function defined as improvement or no further progression of motor deficits. Other study end points included ambulatory status, local progression-free survival, and overall survival. End points were evaluated immediately after RT and at 1, 3, and 6 months thereafter.

RESULTS:

At 1 month, overall response rates regarding motor function were 87.2% after 4 Gy × 5 and 89.6% after 3 Gy × 10 (P = .73). Improvement rates were 38.5% and 44.2%, respectively, no further progression rates 48.7% and 45.5%, respectively, and deterioration rates 12.8% and 10.4%, respectively (P = .44). Ambulatory rates at 1 month were 71.8% and 74.0%, respectively (P = .86). At other times after RT, the results were also not significantly different. Six-month local progression-free survival was 75.2% after 4 Gy × 5 and 81.8% after 3 Gy × 10 (P = .51); 6-month overall survival was 42.3% and 37.8% (P = .68).

CONCLUSION:

Short-course RT with 4 Gy × 5 was not significantly inferior to 3 Gy × 10 in patients with MESCC and poor to intermediate expected survival.

Author information

Rades D1, Šegedin B2, Conde-Moreno AJ2, Garcia R2, Perpar A2, Metz M2, Badakhshi H2, Schreiber A2, Nitsche M2, Hipp P2, Schulze W2, Adamietz IA2, Norkus D2, Rudat V2, Cacicedo J2, Schild SE2.​

1Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ. rades.dirk@gmx.net.

2Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.