Do bladder cancer patients with metastatic spinal cord compression benefit from radiotherapy alone?

To investigate the role of radiotherapy (RT) alone in metastatic spinal cord compression (MSCC) patients with bladder cancer.

Thirty-two MSSC patients with bladder cancer were included in this retrospective review. Potential prognostic factors were investigated for functional outcome, local control of MSCC, and survival: age, gender, performance status, visceral metastases at the time of RT, number of involved vertebrae, ambulatory status, time of developing motor deficits before RT, and radiation schedule (short-course RT [1 week or less] versus long-course RT [2 to 4 weeks]).

Two patients (6%) showed improvement of motor function, 25 (78%) no change, and 5 (16%) deterioration. Better functional outcome was significantly associated with a better performance status (P = 0.035). A trend was observed for absence of visceral metastases (P = 0.054). Five patients developed a recurrence of MSCC in the preirradiated spinal region, which was treated with reirradiation (0 improvement, 4 no change, 1 deterioration). Median survival was 4 months. The 1-year survival rate was only 16%. Better survival was associated with absence of visceral metastases, being ambulatory, involvement of only one to three vertebrae, and better performance status.

Improvement of motor function was rare. For patients not suitable for decompressive surgery, short-course RT seems preferable because it provides a functional outcome similar to that with long-course RT and is more patient convenient. If the patient's prognosis seems extremely poor in terms of functional outcome and survival, single-fraction RT or even best supportive care may be considered.