International survey of the treatment of metastatic spinal cord compression
Samuel Ryu, Ernesto Maranzano, Steven E. Schild, Arjun Sahgal, Yoshiya Yamada, Peter Hoskins, Dirk Rades, Anushree Vichare, Carol Hahn and Tanya Holt
Background and Purpose: Treatment of metastatic spinal cord compression (MSCC) varies significantly. It is useful to understand how radiation oncologists worldwide deal with these challenging and urgent cases. Therefore, a survey of practice patterns of metastatic spinal cord compression was performed among the members of the major radiation oncology organizations in the world to help improve clinical practice.
Material and Methods: The survey questions addressed common clinical issues related to the diagnosis and treatment of spinal cord compression in the context of the available data. The survey of practice pattern in the management of MSCC was performed in 2010. There were a total of 269 survey respondents, and 90% of respondents were from hospital-based practice. Statistical analyses were performed at ASTRO headquarter using Microsoft Excel and SPSS.
Results: The practice pattern of initial diagnostic and clinical evaluation of patients for MSCC was fairly uniform across the continents and countries. Treatment decision was largely based on patient’s general condition, overall oncologic status, and concomitant systemic chemotherapy in this survey. EBRT dose and fractionation patterns were determined by considering the estimated survival time, neurological status such as ambulatory status, previous radiation, and radiation treatment volume. Despite of using similar factors in making treatment decision, there was a significant difference in selecting the radiation dose and fractionation scheme. Selection of re-treatment radiation dose also varied and generally below the published tolerance dose.
Conclusions: Selection of radiation dose and fractionation varied significantly among different continents and countries, while using similar factors to make treatment decision.
Keywords: Spinal cord compression, Spine metastasis, Malignant epidural compression