open access

Vol 22, No 1 (2017)
Original research articles
Published online: 2017-01-01
Submitted: 2015-11-06
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Effectiveness of radiotherapy for metastatic spinal cord compression in patients with short life expectancy

Alexandra Giraldo, Sergi Benavente, Mónica Ramos, Ramona Vergés, Odimar Coronil, Lina Arbeláez, Xavier Maldonado, Manuel Altabas, Meritxell Mollà, Victoria Reyes, Begoña Navalpotro, Jordi Giralt
DOI: 10.1016/j.rpor.2016.09.007
·
Rep Pract Oncol Radiother 2017;22(1):58-63.

open access

Vol 22, No 1 (2017)
Original research articles
Published online: 2017-01-01
Submitted: 2015-11-06

Abstract

Aim

To analyze the effect of radiotherapy (RT) in patients with metastatic spinal cord compression (MSCC) and poor prognosis in our center.

Background

RT is an effective treatment for MSCC.

Materials and methods

Prospective evaluation on patients with MSCC and limited survival (according to Rades’ scale), and treated with single-dose 8[[ce:hsp sp="0.25"/]]Gy RT (February 2013–August 2014). Pain, ambulatory status and sphincter control were recorded. Pain relief was evaluated following the International Bone Metastases Consensus Working Party Guidelines. Ambulatory status was evaluated with Frankel's scale. Spinal fracture and instability were recorded. Health aspects were evaluated via a short survey and measuring the time spent on RT.

Results

35 patients were included. 51% had unfavorable histologies; 60% bone fracture and 17% spinal instability. Median Karnofsky score was 60; 100% were on high doses of opioids. Median survival was 1.5 months. 49% had a partial pain response at 2 weeks post-radiation, and 47% at one month. Significant reductions in pain intensity were present at 2 weeks (Visual analog scale, VAS score, from 8[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.5 to 5[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.9). Negligible effects were observed on motor and bladder function, along with side effects. KPS score was maintained during follow-up. 80% of patients spent ≤5% of their remaining lifetime on RT. A survey comparison between clinical judgment and the results according to treatment decision consider that these patients merit treatment evaluation.

Conclusions

A moderate pain response tailored to life expectancy can be obtained in patients treated with radiation. 8-Gy single-dose is an option for patients with limited survival.

Abstract

Aim

To analyze the effect of radiotherapy (RT) in patients with metastatic spinal cord compression (MSCC) and poor prognosis in our center.

Background

RT is an effective treatment for MSCC.

Materials and methods

Prospective evaluation on patients with MSCC and limited survival (according to Rades’ scale), and treated with single-dose 8[[ce:hsp sp="0.25"/]]Gy RT (February 2013–August 2014). Pain, ambulatory status and sphincter control were recorded. Pain relief was evaluated following the International Bone Metastases Consensus Working Party Guidelines. Ambulatory status was evaluated with Frankel's scale. Spinal fracture and instability were recorded. Health aspects were evaluated via a short survey and measuring the time spent on RT.

Results

35 patients were included. 51% had unfavorable histologies; 60% bone fracture and 17% spinal instability. Median Karnofsky score was 60; 100% were on high doses of opioids. Median survival was 1.5 months. 49% had a partial pain response at 2 weeks post-radiation, and 47% at one month. Significant reductions in pain intensity were present at 2 weeks (Visual analog scale, VAS score, from 8[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.5 to 5[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.9). Negligible effects were observed on motor and bladder function, along with side effects. KPS score was maintained during follow-up. 80% of patients spent ≤5% of their remaining lifetime on RT. A survey comparison between clinical judgment and the results according to treatment decision consider that these patients merit treatment evaluation.

Conclusions

A moderate pain response tailored to life expectancy can be obtained in patients treated with radiation. 8-Gy single-dose is an option for patients with limited survival.

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Keywords

Limited survival; Metastatic spinal cord compression; Radiotherapy; Poor prognosis

About this article
Title

Effectiveness of radiotherapy for metastatic spinal cord compression in patients with short life expectancy

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 22, No 1 (2017)

Pages

58-63

Published online

2017-01-01

DOI

10.1016/j.rpor.2016.09.007

Bibliographic record

Rep Pract Oncol Radiother 2017;22(1):58-63.

Keywords

Limited survival
Metastatic spinal cord compression
Radiotherapy
Poor prognosis

Authors

Alexandra Giraldo
Sergi Benavente
Mónica Ramos
Ramona Vergés
Odimar Coronil
Lina Arbeláez
Xavier Maldonado
Manuel Altabas
Meritxell Mollà
Victoria Reyes
Begoña Navalpotro
Jordi Giralt

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