Abstract
BackgroundIt is currently not possible to get an approval of our ethics committee for a randomized trial cmparing 5x4 Gy and 10x3 Gy for MSCC that includes patients with favorable survival prognoses. Therefore, this matched-pair study following strict matching criteria was perfomed instead.MethodsIn this study, 142 receiving 5x4 Gy were retrospectively matched (1:1) to 142 patients receiving 10x3 Gy with respect to ten characteristics. These characteristics included age, gender, performance status, tumor type, involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MSCC, pre-RT ambulatory status, and time developing motor deficits.ResultsOn multivariate analysis, post-RT motor function was associated with performance status (p < 0.001), tumor type (p < 0.001), and time developing motor deficits (p < 0.001). RT was successful in 76% of patients receiving 5x4 Gy and 69% receiving 10x3 Gy (p = 0.14). Pre.RT ambulatory status showed a strong trend with respect to local control (LC) of MSCC in the multivariate analysis (p = 0.058). 1-year LC rates were 87% after 5x4 Gy and 93% after 10x3 Gy (p = 0.16). On multivariate analysis, survival (OS) was associated with performance score (p < 0.001), visceral metastases (p < 0.001), and pre-RT ambulatory status (p = 0.004). 1-year OS rates were 68% after 5x4 Gy and 73% after 10x3 Gy (p = 0.64).ConclusionsIn patients irradiated for MSCC who had favorable survival prognoses, post-RT motor function, LC and OS were not significantly different after 5x4 Gy and after 10x3 Gy.
Highlights
It is currently not possible to get an approval of our ethics committee for a randomized trial cmparing 5x4 Gy and 10x3 Gy for metastatic spinal cord compression (MSCC) that includes patients with favorable survival prognoses
Due to ethical considerations this trial was limited to patients with a poor or intermediate survival prognosis, since retrospective studies suggested that patients with more favorable survival prognoses benefit from longer-course RT such as 10x3 Gy in terms of better local control of MSCC
Pre-RT ambulatory status was significantly associated with local control (LC) of MSCC in the univariate analysis (p = 0.027) and showed a strong trend in the multivariate analysis (p = 0.058)
Summary
It is currently not possible to get an approval of our ethics committee for a randomized trial cmparing 5x4 Gy and 10x3 Gy for MSCC that includes patients with favorable survival prognoses This matched-pair study following strict matching criteria was perfomed instead. Due to ethical considerations this trial was limited to patients with a poor or intermediate survival prognosis, since retrospective studies suggested that patients with more favorable survival prognoses benefit from longer-course RT such as 10x3 Gy in terms of better local control of MSCC. Such retrospective studies always bear the risk of selection bias. Because further studies defining the optimal fractionation schedule of RT for MSCC in patients with a more favorable prognosis are required, we performed a matched-pair study with strict matching criteria in an attempt to minimize the inclusion of biases
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