Towards answering the optimal palliative fractionation conundrum: single- versus multi-fraction radiation therapy for spinal cord compression
Annals of Palliative Medicine
Patients with metastatic epidural spinal cord compression (MESCC) often present with loss of neurologic function, pain, and reduction in quality of life, all of which can be improved with palliative radiation therapy (1). A more prolonged treatment course for MESCC, typically delivered as 30 Gy in 10 fractions, has the advantage of delivering a higher biologically equivalent dose (BED), which could allow for more durable local control in a disease state where local control directly impacts
... rectly impacts spinal cord compromise and paralysis (2). However, many patients with MESCC have limited prognoses, and even one week of treatment may impose significant burdens for patients and their caregivers. As a result, shorter courses of palliative radiation therapy in this population can be desirable. S e v e r a l p r e v i o u s t r i a l s s p e c i f i c t o s i m p l e , o r uncomplicated bone metastases have demonstrated similar efficacy between single-fraction radiotherapy (SFRT) and multi-fraction radiotherapy (MFRT) for symptom relief (3-5). Radiation therapy can provide rapid responses for patients with uncomplicated bone metastases (6), and metaanalyses inclusive of over two dozen randomized trials from McMaster University, the Cochrane review, University of Toronto, and other international investigators have all concluded there is no significant difference in treatment response between SFRT and MFRT (7-11).