Rades Dirk, Janssen Stefan, Conde-Moreno Antonio Jose, Cacicedo Jon, Metz Michaela, Veninga Theo, Segedin Barbara, Rudat Volker, Schild Steven E
Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
J Med Imaging Radiat Oncol. 2017 Jun;61(3):388-393. doi: 10.1111/1754-9485.12553. Epub 2016 Nov 2.
Radiotherapy alone still is the most commonly delivered treatment modality for metastatic spinal cord compression (MSCC). MSCC is an emergency situation, which requires treatment as soon as possible. When radiotherapy is performed with the most commonly used approach 10 × 3 Gy (30 Gy in 10 fractions) over 2 weeks, the question has been asked whether an overall treatment time (OTT) of 14-15 days including two weekends without irradiation leads to worse outcomes than OTT of 12 days (beginning of radiotherapy on a Monday resulting in only one weekend break)?
A total of 412 patients with MSCC were included in this retrospective study. Ninety-two patients receiving 10 × 3 Gy over 12 days were compared to 320 patients with an OTT of 14-15 days. Ten additional factors were investigated.
On multivariate analysis, functional outcome was associated with tumour type (P < 0.001), time developing motor deficits (P < 0.001), ambulatory status (P = 0.018) and performance score (P < 0.001); OTT had no significant impact (P = 0.40). On univariate analysis of local control of MSCC (freedom from recurrence in irradiated spinal parts), no factor was significant including OTT (P = 0.66). On multivariate analysis, visceral metastases (P < 0.001), tumour type (P < 0.001), time developing motor deficits (P < 0.001), ambulatory status (P < 0.001) and performance score (P < 0.001) were associated with survival, OTT not even on univariate analysis (P = 0.55).
Since an OTT of 14-15 days had no negative impact on outcomes compared to 12 days, compensation in form of an additional radiation fraction or continuation of radiotherapy during weekends is not required, if radiotherapy cannot be started on a Monday.
单纯放疗仍是转移性脊髓压迫症（MSCC）最常用的治疗方式。MSCC是一种紧急情况，需要尽快进行治疗。当采用最常用的方法在2周内给予10×3Gy（10次分割，共30Gy）放疗时，有人提出疑问，即包括两个无放疗周末在内的14 - 15天总治疗时间（OTT）是否会比12天的OTT（周一开始放疗，仅一个周末休息）导致更差的治疗结果？
本回顾性研究共纳入412例MSCC患者。将12天内接受10×3Gy放疗的92例患者与OTT为14 - 15天的320例患者进行比较。另外还研究了10个因素。
多因素分析显示，功能结局与肿瘤类型（P < 0.001）、出现运动功能障碍的时间（P < 0.001）、行走状态（P = 0.018）和体能评分（P < 0.001）相关；OTT无显著影响（P = 0.40）。对MSCC局部控制（放疗脊髓部位无复发）进行单因素分析时，包括OTT在内的任何因素均无显著意义（P = 0.66）。多因素分析显示，内脏转移（P < 0.001）、肿瘤类型（P < 0.001）、出现运动功能障碍的时间（P < 0.001）、行走状态（P < 0.00I）和体能评分（P < 0.001）与生存率相关，OTT即使在单因素分析时也无关联（P = 0.55）。
由于与12天相比，14 - 15天的OTT对治疗结果无负面影响，因此如果不能在周一开始放疗，无需以增加放疗分割次数或在周末继续放疗的形式进行补偿。
