Radiation therapy in malignant spinal cord compression: what is the current knowledge on fractionation schedules? A systematic literature review.

Malignant spinal cord compression (MSCC) in patients with short life expectancy is most frequently treated with radiotherapy and/or corticosteroids. Hypofractionation has been proven to be efficient in metastatic bone pain, but the level of evidence for hypofractionation in MSCC is limited. Searches were performed in PubMed, Embase and the Cochrane Library for all relevant articles. Two randomised controlled trials (RCTs) were identified. The first RCT compared hypofractionation (8 gray (Gy)×2) with a more fractionated regimen. No differences in symptom control, duration of response or survival were detected. The second RCT compared 8 Gy×2 with 8 Gy×1. No significant differences in symptom control, duration of response or survival were detected. Five prospective non-randomised studies identified no differences in post-treatment motor function. Of 17 identified retrospective studies the largest included 1304 patients, treated with five different regimens ranging from 8 Gy×1 to 2 Gy×20, and found similar post-treatment ambulatory status. A Cochrane review based on the first published RCT concluded that short courses of radiotherapy appear to be justified in patients with a poor prognosis.