Defining the appropriate radiotherapy regimen for metastatic spinal cord compression in non-small cell lung cancer patients

Many different schedules are used world wide for radiotherapy (RT) of metastatic spinal cord compression (MSCC). Non-small cell lung cancer (NSCLC) patients have an extraordinarily poor survival prognosis and would benefit from a short overall treatment time. This retrospective study compares short-course RT (1 × 8 Gy/1 day, 5 × 4 Gy/1 week) and long-course RT (10 × 3 Gy/2 weeks, 15 × 2.5 Gy/3 weeks, 20 × 2 Gy/4 weeks) for functional outcome in 252 NSCLC patients developing MSCC. Improvement of motor function occurred in 14% of patients, no change in 54%, and deterioration in 32%. Functional outcome was affected by the time of developing motor deficits before RT (>14 days better than 1-7 days and 8-14 days, P < 0.001), not by the radiation regimen (P = 0.87). In the short-course RT group, functional outcome was similar for 1 × 8 Gy and 5 × 4 Gy (P = 0.94). Short-course and long-course RT appear similarly effective for MSCC in NSCLC patients. As 1 × 8 Gy and 5 × 4 Gy showed comparable results, 1 × 8 Gy can be considered appropriate.