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Uncertainty exists whether patients with spinal cord compression (SCC) from a highly radiosensitive tumor require decompressive spinal surgery in addition to radiotherapy (RT). This study addressed the question by evaluating patients receiving RT alone for SCC from myeloma.

Background/aim: According to our randomized trial, 5×4Gy was comparable to 10×3Gy for metastatic spinal cord compression. Since it remained unclear whether findings applied to poor and intermediate prognoses patients, subgroup analyses were performed., Patients and Methods: In patients with poor prognoses, 58 received 5×4Gy, 53 received 10×3Gy. In intermediate-prognoses patients, numbers were 43 and 49., Results: In patients with poor prognoses, 1-month overall response (OR) was 85% after 5×4Gy and 10×3Gy (p=0.99), improvement 38% vs. 42%, ambulatory status 60% vs. 64% (p=0.83), 6-month local progression-free survival (LPFS) 75% vs. 69% (p=0.74) and 6-month overall survival (OS) 26% vs. 19% (p=0.43). In patients with intermediate prognoses, 1-month OR was 89% after 5×4Gy and 93% after 10×3Gy (p=0.85), improvement 39% vs. 45%, ambulatory status 84% vs. 82% (p=0.90), 6-month LPFS 79% vs. 92% (p=0.17) and 6-months OS 65% vs. 58% (p=0.65)., Conclusion: 5×4Gy was not significantly inferior to 10x3Gy in both subgroups., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Aim: Malignant spinal cord compression (SCC) is treated with radiotherapy (RT). Additional neurosurgery has become more widely used since a trial showed a benefit for selected patients. Although lymphomas were excluded from that trial, neurosurgery is also increasingly being performed in these patients. This study investigated whether neurosurgery is actually required for this group., Patients and Methods: Twenty-nine patients receiving RT alone for SCC from vertebral lymphoma were analyzed for motor function, walking ability, in-field recurrence and survival., Results: Overall response was 100% (72% improvement, 28% stable). At 1, 6 and 12 months after RT, 83%, 100% and 100% of patients were able to walk; 64%, 100%, and 100% of non-ambulatory patients regained their walking ability. Freedom from in-field recurrence was 100% at 6 and 12 months. Survival rates at 6 and 12 months were 79% and 75%., Conclusion: RT alone resulted in excellent outcomes for SCC from lymphoma. These patients may not require surgery., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: This study was performed to investigate the prognostic impact of the myeloma subtype on the survival prognosis of patients with spinal cord compression (SCC) from myeloma., Patients and Methods: In 238 patients irradiated for SCC from myeloma, the myeloma subtype and 10 additional characteristics were evaluated for survival. These characteristics were fractionation of radiotherapy, age, time from myeloma diagnosis to SCC, presence of extra-osseous lesions, additional osseous lesions, gender, time to developing motor weakness, ability to walk, number of vertebrae affected by SCC and performance status., Results: Immunoglobulin G subtype was associated with significantly better survival than other subtypes both at 1 year (80% vs. 50%) and at 2 years (56% vs. 30%) following radiotherapy of SCC (p<0.001). In the subsequent Cox regression analysis, myeloma subtype maintained significance (risk ratio=2.44; 95% confidence interval=1.56-3.85; p<0.001)., Conclusion: This study identified myeloma subtype as being an independent prognostic factor of survival in patients with SCC from myeloma., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: To develop a tool for predicting survival of elderly patients with malignant spinal cord compression (MSCC) from renal cell carcinoma., Patients and Methods: In 71 elderly patients, 10 factors were analyzed. Predictive scores were generated based on 6-month survival rates., Results: Longer interval from renal cell carcinoma diagnosis to MSCC (p=0.019), lack of visceral metastases (p<0.001), slower progression of motor deficits (p<0.001), ambulation (p<0.001) and better performance status (p=0.002) were positive predictors. On multivariate analysis, interval from renal cell carcinoma diagnosis to MSCC (p=0.022), visceral metastases (p<0.001), time to developing motor dysfunction (p=0.041), gait function (p=0.002) and performance status (p=0.017) remained significant. Predictive scores were 17 to 36 points. Four groups were created: 17-23, 24-26, 27-29 and 30-36 points. Six-month survival rates were 8%, 30%, 69% and 100%, respectively (p<0.001)., Conclusion: This tool improves estimation of survival and personalized treatment options in elderly patients with MSCC from renal cell carcinoma., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: Cancers of unknown primary (CUP) account for about 10% in elderly patients with MESCC. Immediate treatment is indicated. Personalizing treatment for MESCC requires for clear understanding of the patients' survival prognosis. In this case, a tool for estimating survival would be valuable., Patients and Methods: In 104 elderly CUP patients, nine factors were investigated: age, gender, performance score, number of affected vertebrae, ability to walk at presentation for radiotherapy, additional bone metastases, visceral metastases, time developing motor weakness, radiotherapy program., Results: In multivariate analysis, the ability to walk (p=0.011) and visceral metastases (p<0.001) were associated with survival. The following scores were assigned: unable to walk=0, able to walk=1, visceral metastases=0, no visceral metastases=1. Three groups were formed (0, 1 and 2 points) with 6-month survival rates of 7%, 18% and 73% (p<0.001)., Conclusion: This specific tool assists the physician to estimate survival and select for the most suitable radiotherapy program in elderly CUP patients with MESCC., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: Metastatic spinal cord compression (MSCC) is an oncological emergency. Many elderly patients cannot tolerate intensive treatment and need individual approaches accounting for a patient's remaining lifetime. The goal of the present study was to develop a survival score for elderly prostate cancer patients with MSCC., Patients and Methods: Nine characteristics were analyzed in 243 patients: age, performance status, interval from prostate cancer diagnosis until MSCC, affected vertebrae, ambulatory status, further bone lesions, visceral metastases, time developing motor deficits, fractionation schedule., Results: Pre-radiotherapy ambulatory status (p<0.001), visceral metastases (p<0.001) and time developing motor deficits (p<0.001) were significant for survival on Cox regression analysis and included in the survival score. Four groups were defined: 9-12, 13-16, 17-19 and 21-23 points. Six-month survival rates were 7%, 28%, 71% and 95%, respectively (p<0.001)., Conclusion: The present study identified four groups with different survival probabilities that require treatment strategies with different priorities ranging from symptom control to prolongation of life., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)