Prognostic significance of the time of developing motor deficits before radiation therapy in metastatic spinal cord compression: One-year results of a prospective trial

Purpose: To investigate prospectively the prognostic value of the time of d eveloping motor deficits before radiation therapy (RT) for post-treatment f unctional outcome in metastatic spinal cord compression. Methods and Materials: From November 1998 until October 1999, 57 patients w ere included. Two subgroups were formed according to the time of developing motor deficits before RT: 1-14 days (n = 29) and > 14 days (n = 28). Thera peutic effect on motor function was evaluated by an g-point scale directly, 6, 12, and 24 weeks after RT, Patients with rapid deterioration of motor f unction within 48 h before RT (n = 14) were evaluated separately. Results: Directly after RT, 26/28 patients (93%) of the group developing mo tor deficits > 14 days showed improvement of motor function, in comparison to 3/29 patients (10%) of the group 1-14 days (p < 0.001). Deterioration ra tes were 0% (> 14 days) and 45% (1-14 days). In patients with rapid deterio ration of motor function within 48 h before RT, prognosis was poor (improve ment 0%, no change 43%, deterioration 57%), Results were comparable 6, 12, and 24 weeks after RT. Conclusion: A slower,development of motor deficits before RT predicts a bet ter post-treatment functional outcome. In patients with rapid deterioration of motor function within 48 h before RT, prognosis was extraordinarily poo r. These results support the findings of our preceding retrospective analys is. (C) 2000 Elsevier Science Inc.