# Clinical Outcomes and Prognostic Factors of Stereotactic Radiotherapy for Spinal Metastases With Epidural Spinal Cord Compression Grades 1–2

## TL;DR

Stereotactic radiotherapy effectively controls spinal metastases with minimal side effects in patients with mild spinal cord compression.

## Contribution

Demonstrates that stereotactic radiotherapy alone is effective for spinal metastases with Grades 1–2 compression without surgery.

## Key findings

- SBRT achieved high local control with only three out of 71 lesions showing progression.
- Toxicity was low, with no spinal cord injuries and minimal acute or late side effects.
- ESCC grading did not significantly affect treatment outcomes.

## Abstract

Investigate the efficacy of stereotactic radiotherapy in patients with metastatic tumors accompanied by epidural spinal cord compression (ESCC) of Grades 1–2 but without vertebral instability who did not undergo surgery.

Based on lesion volume and spinal cord compression degree, SBRT doses of 24 Gy/1f, 30 Gy/3f, and 40 Gy/5f were given. The primary endpoint was local progression‐free survival (LPFS). Secondary endpoints included toxicity and overall survival (OS). A comparative analysis of LPFS outcomes among different ESCC grades was conducted, and multivariate analysis was used to assess factors influencing local treatment efficacy.

Among 71 lesions, only three showed local progression. No statistically significant difference in LPFS was observed between ESCC Grades 1 and 2 (p = 0.769). Esophagitis/oral mucositis occurred in 15 cases (33.3%), including 1 case of Grade 3 (2.2%). Nausea occurred in 14 cases (19.7%), with 12 cases of Grade 1 (16.9%) and 2 cases of Grade 2 (2.8%). Vomiting occurred in 3 cases (4.2%), with 2 cases of Grade 1 (2.8%) and 1 case of Grade 2 (1.4%). Acute pain occurred in 3 cases (4.2%). One case (1.4%) had late neurological damage of Grade 2, and there were no cases of spinal cord injury. ESCC grading was not a significant factor affecting LPFS in tumor SBRT (p = 0.693).

Preliminary findings suggest that for ESCC Grades 1–2 metastatic tumor patients who have no vertebral instability, stereotactic radiotherapy alone has outstanding local control and minimal toxicity. SBRT could be an effective alternative to surgery combined with radiotherapy.