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Radiation Oncology • Palliation
For epidural spinal cord compression in good-performance/prognosis patients who are otherwise inoperable, do you still aim for 30 Gy in 10 fractions, or are you fine with 20 Gy in 5 fractions?
Answer from: Radiation Oncologist at Academic Institution
In general, if prognosis is good (e.g., greater than roughly 6-12 months), 30 Gy in 10 fractions is preferred, given a lesser risk of recurrence with epidural spinal cord compression (ESCC) as compared to lower dose regimens such as 4 Gy x 5 in the longer term (e.g., from Rades et al., PMID 15908648...
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Answer from: Radiation Oncologist at Academic Institution
For patients with high-grade epidural compression with reasonable performance status/prognosis who are not surgical candidates, we favor long-course radiotherapy based on anticipated improvements in local control (81% vs. 61% at 1 year, Rades et al., PMID 20452136), a critical goal given the risks o...
Answer from: Radiation Oncologist at Academic Institution
As highlighted by Dr. @Balboni and Dr. @Butala's excellent answers, I think using the NOMS framework (Barzilai et al., PMID 28640703) helps inform how to approach different patients with "cord compression."
Neurologic: extent of cord compression/neurologic compromise (ESCC 1A very different from 3)...