Primary and postoperative radiotherapy in acute neurological symptoms due to malignant spinal compression: retrospective analysis from a German university hospital

Malignant spinal cord compression (MSCC) can lead to immediate neurological impairment. In order to preserve and, optimally, restore neurological functions, urgent treatment (usually, within 24 h) is necessary. Treatment options mainly consist of decompressive surgery (DS) and / or radiotherapy (RT) combined with steroids. Whereas historically, RT was the treatment of choice, DS has become standard of care, where applicable. Despite a variety of excellent studies, real world data of treatment in a large academic center is currently underrepresented. We performed a retrospective analysis of patients treated for MSCC in our department of radiotherapy between 1998 and 2018 (n = 131), evaluating treatment, achievement of clinically determined improvement of neurological functions as well as overall survival (OS) and treatment-related toxicity. Kaplan-Meier estimator was used for survival statistics, log rank test for survival time comparisons, univariable and multivariable Cox regression and logistic regression for assessing potential impacts of variables on survival and symptom relief. 42.7% of patients had DS before RT (n = 56), 57.3% (n = 75) received RT without DS. Symptom relief was achieved in 41.2% of all patients (n = 54, n = 26 of those had DS before RT, p = 0.12). RT completed as intended (p < 0.001) was statistically significant for symptom relief, wherein symptom relief (p < 0.001), completion of RT course as intended (p = 0.01) and more recent treatment dates (p = 0.002) were independent predictors for OS. We herein present a large cohort of patients treated for MSCC in our academic center, representing real world treatment data currently lacking in literature.