EFFECT OF HIGH-DOSE DEXAMETHASONE IN CARCINOMATOUS METASTATIC SPINAL-CORD COMPRESSION TREATED WITH RADIOTHERAPY - A RANDOMIZED TRIAL

We performed a randomised single blind trial of high-dose dexamethason e as an adjunct to radiotherapy in patients with metastatic spinal cor d compression from solid tumours. After stratification for primary tum our and gait function, 57 patients were allocated randomly to treatmen t with either high-dose dexamethasone or no steroidal treatment. Dexam ethasone was administered as a bolus of 96 mg intravenously, followed by 96 mg orally for 3 days and then tapered in 10 days. A successful t reatment result defined as gait function after treatment was obtained in 81% of the patients treated with dexamethasone compared to 63% of t he patients receiving no dexamethasone therapy. Six months after treat ment, 59% of the patients in the dexamethasone group were still ambula tory compared to 33% in the no dexamethasone group. Life table analysi s of patients surviving with gait function showed a significantly bett er course in patients treated with dexamethasone (P < 0.05). Median su rvival was identical in the two treatment groups. Similar results were found in subgroup analysis of 34 patients with breast cancer as the p rimary malignancy. Significant side-effects were reported in 3 (11%) o f the patients receiving glucocorticoids, 2 of whom discontinued the t reatment. We conclude that high-dose glucocorticoid therapy should be given as adjunct treatment in patients with metastatic epidural spinal cord compression.