RADIOTHERAPY OF METASTATIC SPINAL CORD COMPRESSION IN VERY ELDERLY PATIENTS

¿Cómo tratamos las compresiones medulares de nuestros pacientes ancianos?.

¿Somos pesimistas o tal vez somos optimistas en los tratamientos con radioterapia?

David Muñoz Carmona

Purpose: Owing to the aging of the population, the proportion of elderly patients receiving cancer treatment has
increased. This study investigated the results of radiotherapy (RT) for metastatic spinal cord compression
(MSCC) in the very elderly, because few data are available for these patients.
Methods and Materials: The data from 308 patients aged >75 years who received short-course (treatment time
1–5 days) or long-course RT (2–4 weeks) for MSCC were retrospectively analyzed for functional outcome, local
control, and survival. Furthermore, nine potential prognostic factors were investigated: gender, performance
status, interval from tumor diagnosis to MSCC, tumor type, number of involved vertebrae, other bone or visceral
metastases, ambulatory status, and speed at which motor deficits developed.
Results: Improvement of motor deficits occurred in 25% of patients, with no further progression of MSCC in an
additional 59%. The 1-year local control and survival rate was 92% and 43%, respectively. Improved functional
outcomes were associated with ambulatory status and slower developing motor deficits. Improved local control
resulted from long-course RT. Improved survival was associated with a longer interval from tumor diagnosis to
MSCC, tumor type (breast/prostate cancer, myeloma/lymphoma), lack of visceral or other bone metastases,
ambulatory status, and a slower development of motor deficits.
Conclusion: Short- and long-course RT are similarly effective in patients aged >75 years regarding functional
outcome and survival. Long-course RT provided better local control. Patients with better expected survival
should receive long-course RT and others short-course RT. The criteria for selection of an appropriate regimen
for MSCC in very elderly patients should be the same as for younger individuals.

DIRK RADES, M.D.,*† PETER J. HOSKIN, M.D.,‡ JOHANN H. KARSTENS, M.D.,§ VOLKER RUDAT, M.D.,

THEO VENINGA, M.D.,¶ LUKAS J. A. STALPERS, M.D.,# STEVEN E. SCHILD, M.D.,**
AND JUERGEN DUNST, M.D.*