Department of Radiation Oncology, University of Lubeck, Germany.
Int J Radiat Oncol Biol Phys. 2011 Feb 1;79(2):524-30. doi: 10.1016/j.ijrobp.2009.10.073. Epub 2010 May 6.
Many patients with metastatic spinal cord compression (MSCC) live long enough to develop a recurrence in the irradiated spinal area. This is the first prospective study that has compared local control of different radiotherapy schedules for MSCC.
A total of 265 patients treated with radiotherapy alone were included in this prospective nonrandomized study. The primary goal was to compare local control from short-course (1 × 8 Gy/5 × 4 Gy, n = 131) and long-course radiotherapy (10 × 3 Gy/15 × 2.5 Gy/20 × 2 Gy, n = 134). Secondary end points were motor function and survival. The analysis of local control (no MSCC recurrence in the irradiated spinal area) included the 224 patients with improvement or no change of motor deficits during radiotherapy. Eleven additional factors were evaluated for outcomes.
One-year local control was 61% after short-course and 81% after long-course radiotherapy (p = 0.005). On multivariate analysis (MVA), improved local control was associated with long-course radiotherapy (p = 0.018). Motor function improved in 37% after short-course and 39% after long-course radiotherapy (p = 0.95). Improved motor function was associated with better performance status (p = 0.015), favorable tumor type (p = 0.034), and slower development of motor deficits (p < 0.001). One-year survival rates were 23% after short-course and 30% after long-course radiotherapy (p = 0.28). On MVA, improved survival was associated with better performance status (p < 0.001), no visceral metastases (p < 0.001), involvement of only one to three vertebrae (p = 0.040), ambulatory status (p = 0.038), and bisphosphonate administration after radiotherapy (p < 0.001).
Long-course radiotherapy was associated with better local control, similar functional outcome, and similar survival compared to short-course radiotherapy. Patients with a relatively favorable expected survival should receive long-course radiotherapy.
许多患有转移性脊髓压迫症（MSCC）的患者的存活时间足以使其在放射治疗区域内复发。这是第一项比较 MSCC 不同放射治疗方案局部控制效果的前瞻性研究。
这项前瞻性非随机研究共纳入 265 例单独接受放疗的患者。主要目标是比较短程（1×8 Gy/5×4 Gy，n=131）和长程放疗（10×3 Gy/15×2.5 Gy/20×2 Gy，n=134）的局部控制效果。次要终点是运动功能和生存。局部控制（放射治疗区域内无 MSCC 复发）的分析包括在放疗过程中运动功能改善或无变化的 224 例患者。还评估了 11 个其他因素对结果的影响。
短程和长程放疗的 1 年局部控制率分别为 61%和 81%（p=0.005）。多变量分析（MVA）显示，长程放疗与改善的局部控制效果相关（p=0.018）。短程和长程放疗后运动功能改善的比例分别为 37%和 39%（p=0.95）。运动功能的改善与更好的表现状态（p=0.015）、有利的肿瘤类型（p=0.034）和运动功能减退的发展较慢（p<0.001）相关。短程和长程放疗后 1 年的生存率分别为 23%和 30%（p=0.28）。MVA 显示，改善的生存与更好的表现状态（p<0.001）、无内脏转移（p<0.001）、仅累及 1 至 3 个椎体（p=0.040）、活动状态（p=0.038）和放疗后使用双膦酸盐（p<0.001）相关。
与短程放疗相比，长程放疗与更好的局部控制效果、相似的功能结果和相似的生存率相关。预期生存相对较好的患者应接受长程放疗。
