Abstract
Objective: The optimal treatment of patients with metastatic spinal cord compression (MSCC) is still being de- bated. This randomized trial was planned to compare the functional outcome and its related prognostic factors, toxicity and in-field recurrence of the three schedules of radiotherapy. Methods: Two hundred and eighty five patients enrolled in the study of which 95 received 1 × 8 Gy, 100 received 10 x 3 Gy and 90 received the radiation treatment of 20 × 2 Gy. Irradiation was performed with 6-10 Mv linear accelerators or cobalt-60 units by single posterior field or parallel opposed fields according to depth of irradiation spines. Premedication with dexamethasone was started from the first day of clinico-radiologic diagnosis till 4-5 days after the end of radiotherapy (RT) then tapered off during 10 days. Potential prognostic factors were evaluated with respect to functional outcome. Results: All groups were balanced for patient's characteristics and potential prognostic factors. No statistically significant difference was observed between the 3 groups as regard functional outcome and toxicity while single fraction was associated with higher in-field recurrences (22.8%) with statistically significant difference between the 3 groups (P = 0.01). Functional outcome was significantly better with younger age (≤ 60 y), Eastern Cooperative Oncology Group performance status (ECOG-PS) of 1-2, involved vertebra of 1-2, favorable tumor type, absence of visceral or other bone metastasis, decreased time of developing motor deficit before radiotherapy, long interval between cancer diagnosis to metastatic spinal cord compression, and normal ambulatory status. Conclusion: The three schedules provided similar func- tional outcome. Single-radiation dose was associated with higher in-field recurrence. To minimize treatment time and costs, the dose of 1 × 8 Gy is recommended for patients with poor predicated survival and 10 × 3 Gy for other patients.
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