Does One Size Fit All? Is There a Standard Radiation Dose for Malignant Spinal Cord Compression
In this edition of the Journal of Supportive Oncology, Loblaw and Mitera have published a succinct review of trials of radiotherapy (RT) dose schedules for treating malignant spinal cord compression (MSCC). Treatment options for MSCC include surgery and RT, with the latter being the most commonly utilized option as the majority of patients are unfit to undergo surgery. This concise review of RT dose for spinal cord compression sheds light in an area where there are very few randomized controlled trials. Clinicians have historically favored multiple fraction regimens for treating patients with MSCC. The most common regimes are either 20 Gy in five fractions or 30 Gy in 10 fractions, with a single fraction of 8 Gy mainly reserved for patients with a poor performance status. Prospective studies suggest a different set of prognostic factors for deciding the dose of RT in these patients.
References [PubMed ID in brackets]
1 D. Rades, F. Fehlauer, R. Schulte, T. Veninga, L.J. Stalpers, H. Basic, A. Bajrovic, P.J. Hoskin, S. Tribius, I. Wildfang, V. Rudat, R. Engenhart-Cabilic, J.H. Karstens, W. Alberti, J. Dunst and S.E. Schild, Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol, 24 21 (2006), pp. 3388–3393.
2 E. Maranzano, P. Latini, S. Beneventi, L. Marafioti, F. Piro, E. Perrucci and M. Lupattelli, Comparison of two different radiotherapy schedules for spinal cord compression in prostate cancer. Tumori, 84 4 (1998), pp. 472–477.
3 E. Maranzano, R. Bellavita, R. Rossi, V. De Angelis, A. Frattegiani, R. Bagnoli, M. Mignogna, S. Beneventi, M. Lupattelli, P. Ponticelli, G.P. Biti and P. Latini, Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase III, randomized, multicenter trial. J Clin Oncol, 23 15 (2005), pp. 3358–3365.
4 E. Maranzano, F. Trippa, M. Casale, S. Costantini, M. Lupattelli, R. Bellavita, L. Marafioti, S. Pergolizzi, A. Santacaterina, M. Mignogna, G. Silvano and V. Fusco, 8Gy single-dose radiotherapy is effective in metastatic spinal cord compression: results of a phase III randomized multicentre Italian trial. Radiother Oncol, 93 2 (2009), pp. 174–179.
5 D. Rades, M. Lange, T. Veninga, V. Rudat, A. Bajrovic, L.J. Stalpers, J. Dunst and S.E. Schild, Preliminary results of spinal cord compression recurrence evaluation (score-1) study comparing short-course versus long-course radiotherapy for local control of malignant epidural spinal cord compression. Int J Radiat Oncol Biol Phys, 73 1 (2009), pp. 228–234.
6 D. Rades, P.J. Hoskin, L.J. Stalpers, R. Schulte, P. Poortmans, T. Veninga, J. Dahm-Daphi, N. Obralic, I. Wildfang, R. Bahrehmand, R. Engenhart-Cabilic and S.E. Schild, Short-course radiotherapy is not optimal for spinal cord compression due to myeloma. Int J Radiat Oncol Biol Phys, 64 5 (2006), pp. 1452–1457.
7 D. Rades, L.J. Stalpers, T. Veninga, V. Rudat, R. Schulte and P.J. Hoskin, Evaluation of functional outcome and local control after radiotherapy for metastatic spinal cord compression in patients with prostate cancer. J Urol, 175 2 (2006), pp. 552–556.
8 D. Rades, T. Veninga, L.J. Stalpers, R. Schulte, P.J. Hoskin, P. Poortmans, S.E. Schild and V. Rudat, Prognostic factors predicting functional outcomes, recurrence-free survival, and overall survival after radiotherapy for metastatic spinal cord compression in breast cancer patients. Int J Radiat Oncol Biol Phys, 64 1 (2006), pp. 182–188.
9 D. Rades, F. Fehlauer, L.J. Stalpers, I. Wildfang, O. Zschenker, S.E. Schild, H.J. Schmoll, J.H. Karstens and W. Alberti, A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression: final results of a multicenter study. Cancer, 101 11 (2004), pp. 2687–2692.
10 D. Rades, T. Veninga, L.J. Stalpers, H. Basic, V. Rudat, J.H. Karstens, J. Dunst and S.E. Schild, Outcome after radiotherapy alone for metastatic spinal cord compression in patients with oligometastases. J Clin Oncol, 25 1 (2007), pp. 50–56.
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Correspondence to: Ramachandran Venkitaraman, MD, MRCP, FRCR, Suffolk Oncology Centre, Ipswich Hospital NHS, Heath Road, Ipswich, IP4 5PD, UK; telephone: (0044) 1473704177; fax: (0044) 1473704916
Author Vitae
Dr. Venkitaraman is Consultant Clinical Oncologist, Suffolk Oncology Centre, Ipswich Hospital NHS, Ipswich, United Kingdom.
