Originally published as JCO Early Release 10.1200/JCO.2005.08.193 on February 28 2005

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Short-Course Versus Split-Course Radiotherapy in Metastatic Spinal Cord Compression: Results of a Phase III, Randomized, Multicenter Trial

From the Radiation Oncology Center, Azienda Ospedaliera, Terni; Radiation Oncology Center, University School of Medicine, and Service of Medical Physics, Policlinico Hospital; Medical Oncology Service, Azienda Sanitaria n.2, Perugia; Radiation Oncology Center, Hospital, Arezzo; Radiation Oncology Center, Hospital, Lucca; and Radiation Oncology Center, University School of Medicine, Careggi Hospital, Firenze, Italy

Address reprint requests to Ernesto Maranzano, MD, U.O. di Radioterapia Oncologica, Azienda Ospedaliera ‘S Maria’, Via T di Joannuccio, 1, 05100 Terni, Italy; e.mail: ernesto.maranzano{at}libero.it

PURPOSE: Hypofractionated radiotherapy (RT) is often used in the treatment of metastatic spinal cord compression (MSCC). This randomized trial was planned to assess the clinical outcome and toxicity of two different hypofractionated RT regimens in MSCC.

PATIENTS AND METHODS: Three hundred patients with MSCC were randomly assigned to a short-course RT (8 Gy x 2 days) or to a split-course RT (5 Gy x 3; 3 Gy x 5). Only patients with a short life expectancy entered the protocol. Median follow-up was 33 months (range, 4 to 61 months).

RESULTS: A total of 276 (92%) patients were assessable; 142 (51%) treated with the short-course and 134 (49%) treated with the split-course RT regimen. There was no significant difference in response, duration of response, survival, or toxicity found between the two arms. When short- versus split-course regimens were compared, after RT 56% and 59% patients had back pain relief, 68% and 71% were able to walk, and 90% and 89% had good bladder function, respectively. Median survival was 4 months and median duration of improvement was 3.5 months for both arms. Toxicity was equally distributed between the two arms: grade 3 esophagitis or pharyngitis was registered in four patients (1.5%), grade 3 diarrhea occurred in four patients (1.5%), and grade 3 vomiting or nausea occurred in 10 patients (6%). Late toxicity was never recorded.

CONCLUSION: Both hypofractionated RT schedules adopted were effective and had acceptable toxicity. However, considering the advantages of the short-course regimen in terms of patient convenience and machine time, it could become the RT regimen of choice in the clinical practice for MSCC patients.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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  JCO 2005 23: 3308-3310 [Full Text]

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