Malignant Spinal Cord Compression Treated with Palliative Radiotherapy: The Prince of Wales Hospital Experience

LC Wong, P Choi

Hong Kong J Radiol 2001;4:202-8

Objective: To assess the functional outcome and survival of patients with malignant spinal cord compression following palliative radiotherapy, with or without surgery.

Materials and Methods: Medical records of 50 patients with malignant spinal cord compression, scheduled for palliative radiotherapy between January 1997 and December 1998, were reviewed. Forty two patients received primary palliative radiotherapy, while six received post-decompression radiotherapy. Dose fractionation used was 24 to 30 Gy/4 to 10 fractions/1 to 2 weeks. All patients received oral or intravenous dexamethasone 16 mg daily. Specific outcome indicators were analysed, including ambulatory status, motor power, sensation, continence, pain control, and median survival (compression to death).

Results: Median duration of symptoms before the diagnosis of malignant spinal cord compression was 5 days (95% confidence interval 4 to 1 0). Minimum and maximum follow-up was 21 days and 24 months respectively. Median follow-up was 38.5 days. Different outcome indicators were either maintained or improved in between 79 to 100% of patients. Median survival was 51 days (95% confidence interval 34 to 68). Significant adverse factors for survival included primary site (lung; p = 0.0001), and poor pre-radiotherapy ambulatory status (difficulty in walking or paraplegia; p = 0.0436). The combined treatment modality group had a higher median survival (p = 0.0023) but this may reflect selection bias.

Conclusions: This retrospective study showed that palliative radiotherapy was effective in maintaining and improving functional outcome in patients with malignant spinal cord compression. Patients with primary lung carcinoma, poor performance status, or poor neurological status are an appropriate patient group for short-course palliative radiotherapy. A prospective study investigating dose fractionation regimens and assessing quality of life is needed.