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Hypofractionated stereotactic body radiation therapy for metastatic epidural spinal cord Compression: A case series study

Year: 2025

Type: article

Abstract: BACKGROUND AND PURPOSE: To describe the clinical outcomes of patients with metastatic epidural spinal cord compression (MESCC) treated with hypofractionated stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: The outcomes of MESCC patients who underwent SBRT at our institution from January 2021 to September 2023 were retrospectively reviewed. The prescribed dose was 30-35 Gy delivered in five fractions over 7 days. Differences between complete pain relief, local control (LC), overall survival (OS), and adverse reaction rates between the groups were evaluated at different time points. RESULTS: The study cohort included 63 patients (91 lesions) with a median follow-up of 12 months. Complete pain relief rates at post-treatment months 1, 3, and 6 were 28.6 %, 44.4 %, and 45.3 %, respectively, with no significant difference between patients with low-grade vs. high-grade MESCC. The 1-year LC rate was 91.4 % (32/35) and the 1- and 2-year OS rates were 83.1 % and 46.1 %, respectively, with no significant difference between the low-grade and high-grade MESCC groups. Furthermore, 87.5 % (14/16) of patients with high-grade MESCC exhibited a decrease in Bilsky score at 3 months post-treatment, and the majority remained stabilized at 6 months. However, nine (14.3 %) patients developed new or worsening vertebral compression fractures. CONCLUSION: Hypofractionated SBRT presents a feasible option for MESCC. For patients with high-grade MESCC who are unsuitable for surgery or refuse surgical intervention, SBRT can effectively relieve spinal cord compression.

Source: Radiotherapy and Oncology

DOI: 10.1016/j.radonc.2025.111320