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

Author:

Rades Dirk1,Fehlauer Fabian1,Schulte Rainer1,Veninga Theo1,Stalpers Lukas J.A.1,Basic Hiba1,Bajrovic Amira1,Hoskin Peter J.1,Tribius Silke1,Wildfang Ingeborg1,Rudat Volker1,Engenhart-Cabilic Rita1,Karstens Johann H.1,Alberti Winfried1,Dunst Juergen1,Schild Steven E.1

Affiliation:

1. From the Department of Radiation Oncology, University Hospital Hamburg-Eppendorf; Department of Radiotherapy, Medical Center Hamburg, Hamburg; Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck; Department of Radiotherapy, Siloah Hospital; Department of Radiation Oncology, Medical School, Hannover; Department of Radiation Oncology, St Josef Hospital, Ruhr University, Bochum; Department of Radiation Oncology, Philipps University, Marburg, Germany; Department of Radiation...

Abstract

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.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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