Rades Dirk, Fehlauer Fabian, Veninga Theo, Stalpers Lukas J A, Basic Hiba, Hoskin Peter J, Rudat Volker, Karstens Johann H, Schild Steven E, Dunst Juergen
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany.
Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):532-7. doi: 10.1016/j.ijrobp.2006.08.047. Epub 2006 Nov 2.
Patients with cancer of unknown primary (CUP) account for about 10% of patients with metastatic spinal cord compression (MSCC). This study aims to define the appropriate radiation regimen for these patients.
Data of 143 CUP patients irradiated for MSCC were retrospectively evaluated. Short-course radiotherapy (RT) (1x8 Gy, 5x4 Gy, n = 68) and long-course RT (10x3 Gy, 15x2.5 Gy, 20x2 Gy, n = 75) plus 8 further potential prognostic factors (age, gender, performance status, visceral metastases, other bone metastases, number of involved vertebrae, ambulatory status, time of developing motor deficits before RT) were compared for functional outcome and survival.
Improvement of motor function occurred in 10% of patients, no further progression of motor deficits in 57%, and deterioration in 33%. On multivariate analysis, functional outcome was positively associated with slower development of motor deficits (p < 0.001), absence of visceral metastases (p = 0.008) and other bone metastases (p = 0.027), and ambulatory status (p = 0.054), not with the radiation regimen (p = 0.74). Recurrence of MSCC in the irradiated region occurred in 7 patients after median 6 months. Median survival was 4 months. On multivariate analysis, better survival was significantly associated with absence of visceral metastases (p < 0.001), absence of other bone metastases (p = 0.005), ambulatory status (p = 0.001), and slower development of motor deficits (p = 0.030).
For MSCC treatment in patients with CUP, no significant difference was observed between short-course and long-course RT regarding functional outcome and survival. Short-course RT appears preferable, at least for patients with a poor predicted survival, as it is more patient convenient and more cost-effective.
原发灶不明的癌症（CUP）患者约占转移性脊髓压迫（MSCC）患者的10%。本研究旨在确定这些患者合适的放疗方案。
对143例因MSCC接受放疗的CUP患者的数据进行回顾性评估。比较了短程放疗（RT）（1×8 Gy、5×4 Gy，n = 68）和长程RT（10×3 Gy、15×2.5 Gy、20×2 Gy，n = 75）以及另外8个潜在预后因素（年龄、性别、体能状态、内脏转移、其他骨转移、受累椎体数量、行走状态、放疗前出现运动功能障碍的时间）对功能结局和生存的影响。
10%的患者运动功能得到改善，57%的患者运动功能未进一步恶化，33%的患者运动功能恶化。多因素分析显示，功能结局与运动功能障碍发展较慢（p < 0.001）、无内脏转移（p = 0.008）和其他骨转移（p = 0.027）以及行走状态（p = 0.054）呈正相关，与放疗方案无关（p = 0.74）。放疗区域MSCC复发7例，中位复发时间为6个月。中位生存期为4个月。多因素分析显示，较好的生存与无内脏转移（p < 0.001）、无其他骨转移（p = 0.005）、行走状态（p = 0.001）以及运动功能障碍发展较慢（p = 0.030）显著相关。
对于CUP患者的MSCC治疗，短程和长程RT在功能结局和生存方面未观察到显著差异。短程RT似乎更可取，至少对于预测生存较差的患者，因为它对患者更方便且更具成本效益。
