Radiotherapy for malignant spinal cord compression – prognostic factors for better functional outcome

Abstract

Background. Malignant spinal cord compression (MSCC) is one of the most devastating complications in cancer patients. This retrospective single-center analysis was aimed to identify prognostic factors for better functional outcome after radiotherapy for MSCC.

Patients and methods. Consecutive patients with MSCC treated with upfront radiotherapy between January 2017 and December 2022 were included in this analysis. Data on patient, tumor and treatment characteristics, functional status before and after treatment and diagnostic work-up were collected from the hospital digital database. The treatment was considered effective if performance status (PS) was maintained in PS 1-2 patients or PS improved in PS 3-4 patients.

Results. 295 patients were treated for MSCC. The most common primary tumor type was lung cancer (29.3%), followed by prostate (18%) and breast cancer (12%). The treatment was effective in 44.7% of patients. Patients who survived more than 1 month after radiotherapy were more likely to experience functional improvement than patients who died within the first month (60.5% vs. 16.5%, p<0.001). In the multivariate analysis PS 1-2, myeloma/lymphoma, MRI at the time of MSCC and no motor deficits vs. paralysis were associated with better functional outcome.

Conclusions. The prognosis of patients with MSCC remains poor. Better stratification of patients to assess possible benefit of radiotherapy for MSCC is warranted.