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Prognostic Factors for Local Control and Survival After Radiotherapy of Metastatic Spinal Cord Compression

Dirk Rades, Fabian Fehlauer, Rainer Schulte, Theo Veninga, Lukas J.A. Stalpers, Hiba Basic, Amira Bajrovic, Peter J. Hoskin, Silke Tribius, Ingeborg Wildfang, Volker Rudat, Rita Engenhart-Cabilic, Johann H. Karstens, Winfried Alberti, Juergen Dunst, Steven E. Schild

From the Department of Radiation Oncology, University Hospital Hamburg-Eppendorf; Department of Radiotherapy, Medical Center Hamburg, Hamburg; Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck; Department of Radiotherapy, Siloah Hospital; Department of Radiation Oncology, Medical School, Hannover; Department of Radiation Oncology, St Josef Hospital, Ruhr University, Bochum; Department of Radiation Oncology, Philipps University, Marburg, Germany; Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg; Department of Radiotherapy, Academic Medical Center, Amsterdam, the Netherlands; Department of Radiation Oncology, University Hospital, Sarajevo, Bosnia, and Herzegovina; Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, United Kingdom; and the Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ

Address reprint requests to Dirk Rades, MD, Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany; e-mail: Rades.Dirk{at}gmx.net

PURPOSE: To evaluate potential prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression (MSCC).

PATIENTS AND METHODS: The following potential prognostic factors were investigated retrospectively in 1,852 patients irradiated for MSCC: age, sex, performance status, primary tumor, interval between tumor diagnosis and MSCC ( 15 v > 15 months), number of involved vertebrae (one to two v three), other bone metastases, visceral metastases, pretreatment ambulatory status, time of developing motor deficits before radiotherapy (faster, 1 to 14 v slower, > 14 days), and radiation schedule (short-course v long-course radiotherapy).

RESULTS: On univariate analysis, improved local control of MSCC was associated significantly with favorable histology (breast cancer, prostate cancer, lymphoma/myeloma), no visceral metastases, and long-course radiotherapy. On multivariate analysis, absence of visceral metastases and radiation schedule maintained significance. On univariate analysis, improved survival was associated significantly with female sex, favorable histology, no visceral or other bone metastases, good performance status, being ambulatory before radiotherapy, longer interval between tumor diagnosis and MSCC, and slower development of motor deficits before radiotherapy. Long-course radiotherapy showed a trend. On multivariate analysis, histology, visceral metastases, other bone metastases, ambulatory status before radiotherapy, interval between tumor diagnosis and MSCC, and time of developing motor deficits maintained significance.

CONCLUSION: Poorer local control after radiotherapy for MSCC is associated with visceral metastases and short-course radiotherapy. Long-course radiotherapy seems preferable for patients with more favorable prognoses, given that these patients may live long enough to develop MSCC recurrences. Long-term survival after radiotherapy for MSCC may be predicted if several prognostic factors are considered.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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