RADIATION-THERAPY OF SPINAL METASTASES - RESULTS WITH DIFFERENT FRACTIONATIONS

Aims and Background: Local radiotherapy plays an important role in the palliative treatment of all skeletal metastases, particularly those o f the spine, with the purpose to obtain pain relief and prevent pathol ogic fractures or vertebral collapse. Methods: From June 1991 to Octob er 1993, 95 patients with a total of 103 sites of spinal metastases we re treated at the Institute of Radiology of the University of Rome ''L a Sapienza''. Fractionations and total doses were divided as single fr actions of 800 cGy, hypofractionated multiple fractions for a total do se of 20 Gy administered in 4-5 days, and conventional multiple fracti ons for a total dose of 30-40 Gy in 2-4 weeks. An evaluation of the ef ficacy of the different radiation treatments was performed with the us e of a simplified descriptive pain scale. Results: Seventy-three (70.9 %) of 103 treatments were evaluables. An overall response rate of 82.2 % was obtained: complete in 38.3% and partial in 43.8%, irrespective o f total dose, fractionation and location of irradiated spinal metamere s. The analysis of results did not show significant differences betwee n the treatment courses. Conclusions: We confirm that radiation therap y has a major role in the management of pain control and prevention of fractures in patients with spinal metastases. Hypofractionated and si ngle fraction treatments showed equal efficacy compared to more prolon ged therapy, with an advantage for the patient and the radiation thera py institution.