Review of presentations and radiotherapy outcomes of patients with malignant spinal cord compression
Résumé
Background: Malignant spinal cord compression (MSCC) is the commonest radiotherapy emergency. A high index of suspicion, prompt diagnosis, early referral and treatment is important to restore quality of life and improve survival in patients with MSCC. Aim: This study aimed to evaluate the clinical and treatment characteristics of patients presenting with MSCC at the Radiation Oncology department. Setting: The study was conducted at Steve Biko Academic Hospital, Radiation Oncology. Methods: This is a retrospective review of 110 patients who were treated for MSCC between January 2022 and November 2023. Information on patients’ characteristics, disease characteristics, imaging findings, radiotherapy dose prescription, clinical response and survival was extracted from clinical records. Results: Breast and prostate cancer were the most frequent primary disease sites. Most patients presented in a poor Eastern Cooperative Oncology Group (ECOG) performance status (PS 4), de novo disease (63%) and multilevel vertebral involvement (70%). Eighty-four patients (76.4%) received a single fraction treatment (6 Gy – 8 Gy). The median overall survival was 145 days. Patients with a Rades score of 32–37 points had a statistically significant better overall survival at 1 year compared with those with a score of 22–31 points. There was no difference in survival between single versus multiple fraction treatment. Conclusion: A single fraction radiotherapy schedule is acceptable in this setting where most patients present with extensive disease and non-ambulatory baseline function. Contribution: The findings from this study could be used to establish protocols for treatment strategies in facilities with limited resources.
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