Radiotherapy in metastatic spinal cord compression: a review of fractionation

Abstract

Metastatic spinal cord compression, a term normally including compression of the spinal cord or nerve roots running within the spinal canal, is a common complication of systemic cancer, occurring in 5–10% of all patients with cancer. Recent published data on treatment of metastatic spinal cord compression (MSCC) have shown that radiotherapy (RT) alone is an effective approach for the majority of cases. Except for some protocols, the use of conventional RT (daily fractions of 2 Gy to a total dose of 30–40 Gy) has been abandoned in favour of radiation treatment regimens requiring a smaller number of fractions. In some published trials, 4–5 Gy daily for 8 days followed by 4 days rest, and then 5–16 daily doses of 2–3 Gy have been given with both good results and tolerance. Higher daily fractions ranging from 6 to 10 Gy have also been explored with similar results.

We have summarized the studies comparing the treatments and clinical outcome. Most patients with MSCC have a life expectancy of only several months. In these patients one radiotherapeutic schedule with a short overall treatment time would be the best option, if its effect on the most relevant clinical symptoms, pain and motor dysfunction, is comparable to the effect of more protracted schedules. In patients with a reduced life expectancy, a radiotherapeutic effect on recalcification, which can be expected only several months after RT, is of minor importance. In patients with a life expectancy of more than a few months, recalcification becomes more of an issue and a more fractionated radiation schedule should be considered.