Dose escalation for metastatic spinal cord compression in patients with relatively radioresistant tumors

Dirk Rades, Katja Freundt, Thekla Meyners, Amira Bajrovic, Hiba Basic, Johann H. Karstens, Irenaeus A. Adamietz, Ingeborg Wildfang, Volker Rudat, Steven E. Schild, Juergen Dunst

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Purpose: Radiotherapy alone is the most common treatment for metastatic spinal cord compression (MSCC) from relatively radioresistant tumors such as renal cell carcinoma, colorectal cancer, and malignant melanoma. However, the results of the "standard" regimen 30 Gy/10 fractions need to be improved with respect to functional outcome. This study investigated whether a dose escalation beyond 30 Gy can improve treatment outcomes. Methods and Materials: A total of 91 patients receiving 30 Gy/10 fractions were retrospectively compared to 115 patients receiving higher doses (37.5 Gy/15 fractions, 40 Gy/20 fractions) for motor function and local control of MSCC. Ten further potential prognostic factors were evaluated: age, gender, tumor type, performance status, number of involved vertebrae, visceral or other bone metastases, interval from tumor diagnosis to radiotherapy, pretreatment ambulatory status, and time developing motor deficits before radiotherapy. Results: Motor function improved in 18% of patients after 30 Gy and in 22% after higher doses (p = 0.81). On multivariate analysis, functional outcome was associated with visceral metastases (p = 0.030), interval from tumor diagnosis to radiotherapy (p = 0.010), and time developing motor deficits (p < 0.001). The 1-year local control rates were 76% after 30 Gy and 80% after higher doses, respectively (p = 0.64). On multivariate analysis, local control was significantly associated with visceral metastases (p = 0.029) and number of involved vertebrae (p = 0.043). Conclusions: Given the limitations of a retrospective study, escalation of the radiation dose beyond 30 Gy/10 fractions did not significantly improve motor function and local control of MSCC in patients with relatively radioresistant tumors.

Original languageEnglish (US)
Pages (from-to)1492-1497
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume80
Issue number5
DOIs
StatePublished - Aug 1 2011

Keywords

  • Dose escalation
  • Metastatic spinal cord compression
  • Radioresistant tumors
  • Radiotherapy
  • Treatment outcome

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Rades, D., Freundt, K., Meyners, T., Bajrovic, A., Basic, H., Karstens, J. H., Adamietz, I. A., Wildfang, I., Rudat, V., Schild, S. E., & Dunst, J. (2011). Dose escalation for metastatic spinal cord compression in patients with relatively radioresistant tumors. International Journal of Radiation Oncology Biology Physics, 80(5), 1492-1497. https://doi.org/10.1016/j.ijrobp.2010.04.026