Hypofractionated Radiation Therapy for Pain Relief of Patients With Spinal Metastasis: A Real-World Analysis.

PURPOSE: Spinal metastases may cause pain, neurological compromise, paraplegia, and limb movement disorders; their management requires a comprehensive approach. Alongside systemic anti-tumor therapies, focal interventions such as radiotherapy, bone-modifying agents, and surgery are crucial for slowing disease progression and managing pain in spinal metastases. However, substantial variations exist in radiotherapy regimens for spinal metastases. In this study, we aimed to investigate the safety and efficacy of hypofractionated radiation therapy (HFRT) regimens at our hospital, specifically to evaluate pain relief and incidence of re-irradiation after HFRT.

METHODS

In this retrospective study, data from 58 patients diagnosed with spinal metastasis who received HFRT (4.5-10Gy * 3-7F) at our center between December 2017 and June 2022 were analyzed. All patients were followed up from the initiation of HFRT to either death or their last follow-up visit. Degree of pain was assessed using the numeric rating scale (NRS) before and after 1 month of HFRT. A multivariate Cox regression model was established to identify the independent risk factors for prognostic analysis of spinal metastasis.

RESULTS

HFRT could effectively manage pain in patients with spinal metastasis. The pain scores were significantly decreased after HFRT (3.43 vs. 1.5, p < 0.001), with 84.5% patients experiencing improved pain relief 1 month after radiotherapy. No cases of radiation myelitis were observed during the follow-up period. Furthermore, the incidence of re-radiotherapy was significantly increased in patients with spinal metastases who received moderate HFRT (< 5 Gy/day) (p = 0.01, HR = 0.43).

CONCLUSION

HFRT significantly reduced pain scores and reirradiation rates without increasing radiation myelitis incidence for spinal metastases.