Rades Dirk, Fehlauer Fabian, Stalpers Lukas J A, Wildfang Ingeborg, Zschenker Oliver, Schild Steven E, Schmoll Hans J, Karstens Johann H, Alberti Winfried
Department of Radiation Oncology, University Hospital Hamburg, Hamburg, Germany.
Cancer. 2004 Dec 1;101(11):2687-92. doi: 10.1002/cncr.20633.
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
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.
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.
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.
转移性脊髓压迫症（MSCC）患者的最佳治疗方案仍存在争议。作者前瞻性地开展了一项当前的观察性多中心研究，评估了两种放射治疗（RT）方案以及与功能结局相关的预后因素。
在本研究中，214例MSCC患者于2000年4月至2003年9月期间接受放疗，其中110例患者每2周接受10次分割，每次30格雷（Gy）；104例患者每4周接受20次分割，每次40 Gy。在放疗前及放疗后6个月内评估运动功能和行走状态。研究了以下潜在的预后因素：放疗方案、体能状态、年龄、受照射椎体数量、原发肿瘤类型、放疗前行走状态以及放疗前出现运动功能障碍的时间长度。
两组患者的特征和潜在预后因素均衡。接受30 Gy放疗后，43%的患者运动功能改善；接受40 Gy放疗后，41%的患者运动功能改善（P = 0.799）。放疗后行走率分别为60%和64%（P = 0.708）。多因素分析表明，放疗前运动功能障碍进展较慢（P < 0.001）、原发肿瘤组织学类型良好（P < 0.001）以及放疗前能够行走（P = 0.035）与更好的功能结局相关。放疗方案（P = 0.269）及其他变量无显著影响。急性毒性反应较轻，随访期间未观察到晚期毒性反应。存活≥6个月的患者随访时间为12（6 - 28）个月。
每10次分割给予30 Gy优于每20次分割给予40 Gy，因为其结局相似、治疗时间更短且成本更低。肿瘤类型、放疗前行走状态以及放疗前出现运动功能障碍的时间长度是相关的预后因素，未来研究应予以考虑。
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