1x8 Gy versus 5x4 Gy for metastatic epidural spinal cord compression: a matched-pair study of three prognostic patient subgroups
Por:
Rades D, Conde-Moreno AJ, Cacicedo J, Veninga T, Segedin B, Stanic K, Rudat V, Schild SE
Publicada:
8 feb 2018
Resumen:
Background: This study provides separate comparisons of 1 x 8 Gy to 5 x 4 Gy for metastatic epidural spinal cord compression (MESCC) in patients with poor, intermediate and favorable survival prognoses.
Methods: Patients receiving 1 x 8 Gy were matched to patients receiving 5 x 4 Gy for age, gender, performance status, tumor type, involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MESCC, ambulatory status and time developing motor deficits. From a study including patients with poor (N = 156) or intermediate (N = 86) survival prognoses, subgroup analyses were performed. Furthermore, 232 new patients with favorable prognoses matched the same way were included.
Results: In poor prognoses patients, 6-month survival rates were 10% after 1 x 8 Gy and 6% after 5 x 4 Gy (p = 0.38); in-field reRT rates in few patients alive at 6 months were 15 and 2% (p = 0.16). In intermediate prognoses patients, 6-month survival rates were 49% after 1 x 8 Gy and 58% after 5 x 4 Gy (p = 0.30). ReRT rates at 6 months were 23 and 13% (p = 0.25). In favorable prognoses patients, 6-month survival rates were 89% after 1 x 8 Gy and 91% after 5 x 4 Gy. ReRT rates at 6 months were 14 and 3% (p = 0.007). In no subgroup, RT regimen had a significant impact on motor function.
Conclusions: Since in patients with poor prognoses, outcomes after 1x8 Gy and 5x4 Gy were not significantly different, 1 x 8 Gy may be an option. In patients with intermediate prognoses, a trend was found in favor of 5 x 4 Gy. In patients with favorable prognoses, need for in-field reRT was greater after 1 x 8 Gy.
Filiaciones:
Rades D:
Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Conde-Moreno AJ:
Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain
Cacicedo J:
Department of Radiation Oncology, Cruces University Hospital, Vizcaya, Barakaldo, Spain
Veninga T:
Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, Netherlands
Segedin B:
Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
Stanic K:
Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
Rudat V:
Department of Radiation Oncology, Saad Specialist Hospital, Al-Khobar, Saudi Arabia
Schild SE:
Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
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