Treatment Approach for Bilsky Grade 2 Metastatic Epidural Spinal Cord Compression Based on Radiation Therapy Failure Risk.

Study designRetrospective cohort study.ObjectivesThis study evaluated the outcomes of radiation therapy (RT) as the initial treatment for Bilsky grade 2 metastatic epidural spinal cord compression (MESCC) and identified the risk factors associated with RT failure.MethodsThis retrospective cohort study enrolled 151 patients diagnosed with Bilsky grade 2 MESCC. Patients were divided into 2 groups, viz. those who initially underwent RT (n = 127) and those treated with surgery at presentation (n = 24). The patient demographics, treatment outcomes, and risk factors for RT failure were analyzed. The Spinal Instability Neoplastic Score (SINS) and clinical outcomes such as ambulatory status and neurological function were compared. Logistic regression was performed to identify factors predictive of RT failure.ResultsRT was successful in 85.8% (109/127) of patients, and only 14.2% (18/127) required surgery due to symptom progression. The SINS were significantly higher in the RT-failure group (9.6 ± 3.2) than in the RT-success group (7.4 ± 2.8, = 0.003). SINS scores >8 were associated with a higher risk of RT failure. Patients the surgery group were younger and presented more frequently with neurological deficits. No significant differences in final ambulatory status or survival were observed between the RT-success and RT-failure subgroups.ConclusionsRT can be a viable initial treatment option for Bilsky grade 2 MESCC in the absence of neurological deficits or severe mechanical pain. However, patients with greater spinal instability (SINS >8) face a higher risk of RT failure and may benefit from surgical intervention at diagnosis.