摘要
Objective:The optimal treatment of patients with metastatic spinal cord compression(MSCC) is still being debated.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 functional 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.
