Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression
Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression
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DOI：
10.1200/jco.2005.04.754
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发表时间：
2005-05-20
影响因子：
45.3
通讯作者：
Schild, SE
中科院分区：
文献类型：
--
作者：
Rades, D;Stalpers, LJA;Schild, SE
目的探讨转移性脊髓压迫（MSCC）的5种放疗方案及其影响功能预后的潜在因素。患者与方法回顾性分析1992年1月至2003年12月接受放射治疗的1304例患者。比较1 X 8 Gy 1天（n = 261）、5 X 4 Gy 1周（n = 279）、10 X 3 Gy 2周（n = 274）、15 X 2.5 Gy 3周（n = 233）和20 X 2 Gy 4周（n = 257）的运动功能、活动状态和野内复发情况。研究了以下潜在的预后因素：年龄、性别、运动状态、组织学、受累椎数、从癌症诊断到MSCC的时间间隔、预处理活动状态、以及在移植前出现运动缺陷的时间。结果运动功能改善率分别为26% （1 X 8 Gy）、28% （5 X 4 Gy）、27% （10 X 3 Gy）、31% （15 X 2.5 Gy）和28% (20 X 2 Gy)；治疗后门诊率分别为69%、68%、63%、66%、74% （P = 0.578）。在多变量分析中，年龄、运动状态、原发肿瘤、受累性椎体、从癌症诊断到MSCC的间隔时间、预处理活动状态和出现运动缺陷的时间与功能结果显著相关，而RT计划与功能结果无关。急性毒性较轻，未见晚期毒性。2年现场复发率分别为24% （1 x 8 Gy）、26% （5 x 4 Gy）、14% （10 x 3 Gy）、9% （15 x 2.5 Gy）和7% (20 x 2 Gy) （P < 0.001）。1 × 8 Gy和5 × 4 Gy之间的差异（P = 0.44）以及10 × 3 Gy、15 × 2.5 Gy和20 × 2 Gy之间的差异（P = 0.71）均不显著。结论5种放疗方案的功能预后相似。三个更长的赛程似乎导致了更少的现场重复。为了缩短治疗时间，建议采用以下两种治疗方案：预测生存率差的患者采用1 X 8 Gy，其他患者采用10 X 3 Gy。结果应在前瞻性随机试验中得到证实。(c) 2005年由美国临床肿瘤学会出版
Purpose To study five radiotherapy (RT) schedules and potential prognostic factors for functional outcome in metastatic spinal cord compression (MSCC).Patients and Methods One thousand three hundred four patients who were irradiated from January 1992 to December 2003 were included in this retrospective review. The schedules of 1 X 8 Gy in 1 day (n = 261), 5 X 4 Gy in 1 week (n = 279), 10 X 3 Gy in 2 weeks (n = 274), 15 X 2.5 Gy in 3 weeks (n = 233), and 20 X 2 Gy in 4 weeks (n = 257) were compared for motor function, ambulatory status, and in-field recurrences. The following potential prognostic factors were investigated: age, sex, performance status, histology, number of involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits before RT. A multivariate analysis was performed with the ordered logit model.Results Motor function improved in 26 % (1 X 8 Gy), 28 % (5 X 4 Gy), 27 % (10 X 3 Gy), 31 % (15 X 2.5 Gy), and 28 % (20 X 2 Gy); and posttreatment ambulatory rates were 69 %, 68 %, 63 %, 66 %, and 74 % (P = .578), respectively. On multivariate analysis, age, performance status, primary tumor, involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits were significantly associated with functional outcome, whereas the RT schedule was not. Acute toxicity was mild, and late toxicity was not observed. In-field recurrence rates at 2 years were 24 % (1 x 8 Gy), 26 % (5 x 4 Gy), 14 % (10 X 3 Gy), 9 % (15 X 2.5 Gy), and 7 % (20 x 2 Gy) (P < .001). Neither the difference between 1 x 8 Gy and 5 X 4 Gy (P = .44) nor between 10 X 3 Gy, 15 X 2.5 Gy, and 20 X 2 Gy (P = .71) was significant.Conclusion The five RT schedules provided similar functional outcome. The three more protracted schedules seemed to result in fewer in-field recurrences. To minimize treatment time, the following two schedules are recommended: 1 X 8 Gy for patients with poor predicted survival and 10 X 3 Gy for other patients. Results should be confirmed in a prospective randomized trial. (c) 2005 by American Society of Clinical Oncology