A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression: Final results of a multicenter study

Dirk Rades, Fabian Fehlauer, Lukas J A Stalpers, Ingeborg Wildfang, Oliver Zschenker, Steven E. Schild, Hans J. Schmoll, Johann H. Karstens, Winfried Alberti

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

BACKGROUND. The optimal treatment of patients with metastatic spinal cord compression (MSCC) is still being debated. The current observational multicenter study, performed prospectively by the authors, evaluated two radiotherapy (RT) schedules and prognostic factors with respect to functional outcome METHODS. In the current study, 214 patients with MSCC were irradiated between April 2000 and September 2003 with 30 gray (Gy) per 10 fractions per 2 weeks (n = 110) or with 40 Gy per 20 fractions per 4 weeks (n = 104). Motor function and ambulatory status were evaluated before RT and until 6 months after RT. The following potential prognostic factors were investigated: RT schedule, performance status, age, number of irradiated vertebrae, type of primary tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT. RESULTS. Both groups were balanced for patient characteristics and potential prognostic factors. Motor function improved in 43% of patients after 30 Gy and in 41% of patients after 40 Gy (P = 0.799). Posttreatment ambulatory rates were 60% and 64% (P = 0.708), respectively. A multivariate analysis demonstrated that a slower progression of motor deficits before RT (P < 0.001), a favorable histology of the primary tumor (P < 0.001), and being ambulatory before RT (P = 0.035) were associated with a better functional outcome. RT schedule (P = 0.269) and other variables had no significant impact. Acute toxicity was mild, and late toxicity was not observed during the period of follow-up. Follow-up was 12 (6-28) months in patients surviving ≥ 6 months. CONCLUSIONS. Thirty gray per 10 fractions was preferable to 40 Gy per 20 fractions, because it was associated with similar outcome, less treatment time, and lower costs. The type of tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT were relevant prognostic factors and should be considered in future studies.

Original languageEnglish (US)
Pages (from-to)2687-2692
Number of pages6
JournalCancer
Volume101
Issue number11
DOIs
StatePublished - Dec 1 2004

Fingerprint

Spinal Cord Compression
Multicenter Studies
Appointments and Schedules
Radiotherapy
Therapeutics
Neoplasms
Observational Studies
Histology
Spine
Multivariate Analysis
Costs and Cost Analysis

Keywords

  • Metastatic spinal cord compression
  • Overall treatment time
  • Prognostic factors
  • Radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression : Final results of a multicenter study. / Rades, Dirk; Fehlauer, Fabian; Stalpers, Lukas J A; Wildfang, Ingeborg; Zschenker, Oliver; Schild, Steven E.; Schmoll, Hans J.; Karstens, Johann H.; Alberti, Winfried.

In: Cancer, Vol. 101, No. 11, 01.12.2004, p. 2687-2692.

Research output: Contribution to journalArticle

Rades, D, Fehlauer, F, Stalpers, LJA, Wildfang, I, Zschenker, O, Schild, SE, Schmoll, HJ, Karstens, JH & Alberti, W 2004, 'A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression: Final results of a multicenter study', Cancer, vol. 101, no. 11, pp. 2687-2692. https://doi.org/10.1002/cncr.20633
Rades, Dirk ; Fehlauer, Fabian ; Stalpers, Lukas J A ; Wildfang, Ingeborg ; Zschenker, Oliver ; Schild, Steven E. ; Schmoll, Hans J. ; Karstens, Johann H. ; Alberti, Winfried. / A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression : Final results of a multicenter study. In: Cancer. 2004 ; Vol. 101, No. 11. pp. 2687-2692.
@article{ed02e6b42ab14887ae4004b42d600c89,
title = "A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression: Final results of a multicenter study",
abstract = "BACKGROUND. The optimal treatment of patients with metastatic spinal cord compression (MSCC) is still being debated. The current observational multicenter study, performed prospectively by the authors, evaluated two radiotherapy (RT) schedules and prognostic factors with respect to functional outcome METHODS. In the current study, 214 patients with MSCC were irradiated between April 2000 and September 2003 with 30 gray (Gy) per 10 fractions per 2 weeks (n = 110) or with 40 Gy per 20 fractions per 4 weeks (n = 104). Motor function and ambulatory status were evaluated before RT and until 6 months after RT. The following potential prognostic factors were investigated: RT schedule, performance status, age, number of irradiated vertebrae, type of primary tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT. RESULTS. Both groups were balanced for patient characteristics and potential prognostic factors. Motor function improved in 43{\%} of patients after 30 Gy and in 41{\%} of patients after 40 Gy (P = 0.799). Posttreatment ambulatory rates were 60{\%} and 64{\%} (P = 0.708), respectively. A multivariate analysis demonstrated that a slower progression of motor deficits before RT (P < 0.001), a favorable histology of the primary tumor (P < 0.001), and being ambulatory before RT (P = 0.035) were associated with a better functional outcome. RT schedule (P = 0.269) and other variables had no significant impact. Acute toxicity was mild, and late toxicity was not observed during the period of follow-up. Follow-up was 12 (6-28) months in patients surviving ≥ 6 months. CONCLUSIONS. Thirty gray per 10 fractions was preferable to 40 Gy per 20 fractions, because it was associated with similar outcome, less treatment time, and lower costs. The type of tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT were relevant prognostic factors and should be considered in future studies.",
keywords = "Metastatic spinal cord compression, Overall treatment time, Prognostic factors, Radiotherapy",
author = "Dirk Rades and Fabian Fehlauer and Stalpers, {Lukas J A} and Ingeborg Wildfang and Oliver Zschenker and Schild, {Steven E.} and Schmoll, {Hans J.} and Karstens, {Johann H.} and Winfried Alberti",
year = "2004",
month = "12",
day = "1",
doi = "10.1002/cncr.20633",
language = "English (US)",
volume = "101",
pages = "2687--2692",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "11",

}

TY - JOUR

T1 - A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression

T2 - Final results of a multicenter study

AU - Rades, Dirk

AU - Fehlauer, Fabian

AU - Stalpers, Lukas J A

AU - Wildfang, Ingeborg

AU - Zschenker, Oliver

AU - Schild, Steven E.

AU - Schmoll, Hans J.

AU - Karstens, Johann H.

AU - Alberti, Winfried

PY - 2004/12/1

Y1 - 2004/12/1

N2 - BACKGROUND. The optimal treatment of patients with metastatic spinal cord compression (MSCC) is still being debated. The current observational multicenter study, performed prospectively by the authors, evaluated two radiotherapy (RT) schedules and prognostic factors with respect to functional outcome METHODS. In the current study, 214 patients with MSCC were irradiated between April 2000 and September 2003 with 30 gray (Gy) per 10 fractions per 2 weeks (n = 110) or with 40 Gy per 20 fractions per 4 weeks (n = 104). Motor function and ambulatory status were evaluated before RT and until 6 months after RT. The following potential prognostic factors were investigated: RT schedule, performance status, age, number of irradiated vertebrae, type of primary tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT. RESULTS. Both groups were balanced for patient characteristics and potential prognostic factors. Motor function improved in 43% of patients after 30 Gy and in 41% of patients after 40 Gy (P = 0.799). Posttreatment ambulatory rates were 60% and 64% (P = 0.708), respectively. A multivariate analysis demonstrated that a slower progression of motor deficits before RT (P < 0.001), a favorable histology of the primary tumor (P < 0.001), and being ambulatory before RT (P = 0.035) were associated with a better functional outcome. RT schedule (P = 0.269) and other variables had no significant impact. Acute toxicity was mild, and late toxicity was not observed during the period of follow-up. Follow-up was 12 (6-28) months in patients surviving ≥ 6 months. CONCLUSIONS. Thirty gray per 10 fractions was preferable to 40 Gy per 20 fractions, because it was associated with similar outcome, less treatment time, and lower costs. The type of tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT were relevant prognostic factors and should be considered in future studies.

AB - BACKGROUND. The optimal treatment of patients with metastatic spinal cord compression (MSCC) is still being debated. The current observational multicenter study, performed prospectively by the authors, evaluated two radiotherapy (RT) schedules and prognostic factors with respect to functional outcome METHODS. In the current study, 214 patients with MSCC were irradiated between April 2000 and September 2003 with 30 gray (Gy) per 10 fractions per 2 weeks (n = 110) or with 40 Gy per 20 fractions per 4 weeks (n = 104). Motor function and ambulatory status were evaluated before RT and until 6 months after RT. The following potential prognostic factors were investigated: RT schedule, performance status, age, number of irradiated vertebrae, type of primary tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT. RESULTS. Both groups were balanced for patient characteristics and potential prognostic factors. Motor function improved in 43% of patients after 30 Gy and in 41% of patients after 40 Gy (P = 0.799). Posttreatment ambulatory rates were 60% and 64% (P = 0.708), respectively. A multivariate analysis demonstrated that a slower progression of motor deficits before RT (P < 0.001), a favorable histology of the primary tumor (P < 0.001), and being ambulatory before RT (P = 0.035) were associated with a better functional outcome. RT schedule (P = 0.269) and other variables had no significant impact. Acute toxicity was mild, and late toxicity was not observed during the period of follow-up. Follow-up was 12 (6-28) months in patients surviving ≥ 6 months. CONCLUSIONS. Thirty gray per 10 fractions was preferable to 40 Gy per 20 fractions, because it was associated with similar outcome, less treatment time, and lower costs. The type of tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT were relevant prognostic factors and should be considered in future studies.

KW - Metastatic spinal cord compression

KW - Overall treatment time

KW - Prognostic factors

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=8844275468&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=8844275468&partnerID=8YFLogxK

U2 - 10.1002/cncr.20633

DO - 10.1002/cncr.20633

M3 - Article

C2 - 15493037

AN - SCOPUS:8844275468

VL - 101

SP - 2687

EP - 2692

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 11

ER -