Maranzano E, Latini P
Radiation Oncology Center, Perugia, Italy.
Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):959-67. doi: 10.1016/0360-3016(95)00572-g.
In assessing effectiveness of radiation therapy (RT) in metastatic spinal cord compression (MSCC), we performed a prospective trial in which patients with this complication were generally treated with RT plus steroids, and surgery was reserved for selected cases.
Two hundred seventy-five consecutive patients with MSCC entered this protocol. Twenty (7%) underwent surgery plus RT, another 255 received RT alone. Of all eligible patients, 25 (10%) early deaths and 21 (8%) entering a feasibility study of RT without steroids, were not evaluable. Of the 209 evaluable cases, 110 were females and 99 males, and median age was 62 years. Median follow-up was 49 months (range, 13 to 88) and treatment consisted of 30 Gy RT (using two different schedules) together with steroids (standard or high doses, depending on motor deficit severity). Response was assessed according to back pain and motor and bladder function before and after therapy.
Back pain total response rate was 82% (complete or partial response or stable pain, 54, 17, or 11%, respectively). About three-fourths of the patients (76%) achieved full recovery or preservation of walking ability and 44% with sphincter dysfunction improved. Early diagnosis was the most important response predictor so that a large majority of patients able to walk and with good bladder function maintained these capacities. When diagnosis was late, tumors with favorable histologies (i.e., myeloma, breast, and prostate carcinomas) above all responded to RT. Duration of response was also influenced by histology. Favorable histologies are associated to higher median response (myeloma, breast, and prostate carcinomas, 16, 12, and 10 months, respectively). Median survival time was 6 months, with a 28% probability of survival for 1 year. Survival time was longer for patients able to walk before and/or after RT, those with favourable histologies, and females. There was agreement between patient survival and duration of response, systemic relapse of disease being generally the cause of death.
Early diagnosis of MSCC was a powerful predictor of outcome. Primary tumor histology had weight only when patients were nonwalking, paraplegic, or had bladder dysfunction. The effectiveness of RT plus steroids in MSCC emerged in our trial. The most important factors positively conditioning our results were: the high rate of early diagnoses (52%) and the number of tumors with favorable histologies (124 out of 209, 63%) recruited, and the choice of best treatment based on appropriate patient selection for surgery and RT or RT alone.
在评估放射治疗（RT）对转移性脊髓压迫（MSCC）的疗效时，我们进行了一项前瞻性试验，在此试验中，患有这种并发症的患者一般接受RT加类固醇治疗，而手术仅适用于特定病例。
275例连续的MSCC患者进入本方案。20例（7%）接受了手术加RT，另外255例仅接受RT。在所有符合条件的患者中，25例（10%）早期死亡，21例（8%）进入了无类固醇RT的可行性研究，无法进行评估。在209例可评估病例中，女性110例，男性99例，中位年龄为62岁。中位随访时间为49个月（范围13至88个月），治疗包括30 Gy RT（采用两种不同方案）加类固醇（标准剂量或高剂量，取决于运动功能缺损的严重程度）。根据治疗前后的背痛、运动和膀胱功能评估反应情况。
背痛的总缓解率为82%（完全缓解或部分缓解或疼痛稳定，分别为54%、17%或11%）。约四分之三的患者（76%）实现了完全康复或保留了行走能力，44%有括约肌功能障碍的患者有所改善。早期诊断是最重要的反应预测指标，因此绝大多数能够行走且膀胱功能良好的患者保持了这些能力。当诊断较晚时，组织学类型良好的肿瘤（即骨髓瘤、乳腺癌和前列腺癌）对RT反应最为明显。反应持续时间也受组织学类型影响。组织学类型良好的肿瘤中位反应时间较长（骨髓瘤、乳腺癌和前列腺癌分别为16个月、12个月和10个月）。中位生存时间为6个月，1年生存率为28%。在RT前后能够行走的患者、组织学类型良好的患者以及女性患者的生存时间更长。患者生存与反应持续时间之间存在一致性，疾病的全身复发通常是死亡原因。
MSCC的早期诊断是预后的有力预测指标。仅在患者不能行走、截瘫或有膀胱功能障碍时，原发肿瘤组织学类型才有影响。在我们的试验中，RT加类固醇对MSCC的疗效得以显现。对我们的结果产生积极影响的最重要因素是：早期诊断率高（52%）、招募的组织学类型良好的肿瘤数量多（209例中有124例，63%），以及根据对手术和RT或仅RT的适当患者选择来选择最佳治疗方法。
