Onsite versus offsite radiation treatment of malignant spinal cord compression: lessons from a safety net health system

Abstract

Objective: Metastatic spinal cord compression (MSCC) is an oncologic emergency that often warrants emergent treatment; but, it is unclear whether radiation treatment (RT) can be optimally managed from an offsite radiotherapy facility. Methods: Patient charts from consecutive patients with MSCC who were treated with radiotherapy alone at either an onsite hospital radiation department (from 2008 to 2012) or an offsite radiotherapy centre (2012)(2013)(2014)(2015) were reviewed. Patient clinical parameters were compared across groups with either the x 2 test or Fisher's exact test, while survival curves were compared with the logrank test. The primary end points were ambulatory rate over time, overall survival and cancer-specific survival.Results: A total of 45 patients were identified, with 19 patients treated onsite in the hospital department and 26 patients treated at the offsite radiotherapy centre with median follow-up of 42 days vs 48.5 days, respectively. The ambulatory rate over time, overall survival and cancer-specific survival were not significantly different between the two eras. Patients treated in-hospital were more likely to start treatment the same day as the consult ("sim and treat") (79% vs 27%, p 5 0.006) and were more likely to not complete treatment (26% vs 4%, p 5 0.029) as compared with those treated in the offsite centre. Conclusion: Patients with MSCC can be feasibly treated at an offsite radiotherapy centre with outcomes similar to those treated in-hospital. Advances in knowledge: This is the first study in literature to compare outcomes between onsite and offsite RT of MSCC. INTRODUCTIONMetastatic spinal cord compression (MSCC) can lead to debilitating sequelae in patients with cancer and is considered an oncologic emergency, requiring immediate intervention given the risk of permanent spinal cord injury or death. MSCC generally warrants inpatient management and monitoring, given the possibility of acute change in patient status. Based on a prospective randomized controlled trial, the standard of care for MSCC in most cases is rapid initiation of corticosteroids followed by surgical decompression (if an operable candidate) followed by adjuvant radiation treatment (RT).