Single versus multifraction radiotherapy for spinal cord compression: A systematic review and meta-analysis

Area of Science:

• Oncology
• Radiation Oncology
• Clinical Research

Background:

• Multifraction radiotherapy (MFRT) has been the standard for metastatic epidural spinal cord compression (MESCC).
• Emerging evidence suggests single fraction radiotherapy (SFRT) may offer comparable outcomes.
• This study addresses the efficacy of SFRT versus short-course MFRT in MESCC patients.

Purpose of the Study:

• To compare the functional and overall outcomes of SFRT and short-course MFRT in MESCC patients.
• To conduct a systematic review and meta-analysis of available randomized evidence.
• To evaluate the impact of SFRT versus MFRT on motor response, bladder function, and overall survival.

Main Methods:

• Systematic review and meta-analysis of randomized and non-randomized trials.
• Searched OVID, EMBASE, and Cochrane Central Register up to February 2018.
• Analyzed data using random effects models, reporting relative risks and hazard ratios with 95% confidence intervals.

Main Results:

• Three randomized trials (712 patients) were included.
• No significant differences were found for motor response (RR 0.96), overall survival (HR 1.00), or bladder function (RR 0.97) between SFRT and MFRT.
• Moderate quality of evidence, with insufficient data for quality of life, toxicity, or pain response analysis.

Conclusions:

• Single fraction radiotherapy (SFRT) demonstrates comparable efficacy to multifraction radiotherapy (MFRT) for metastatic epidural spinal cord compression (MESCC).
• No significant differences in motor, bladder, or survival outcomes were observed.
• SFRT represents a potentially equivalent alternative to MFRT for MESCC management.