Short-course radiotherapy (8 Gy x 2) in metastatic spinal cord compression: an effective and feasible treatment. 
To evaluate the clinical outcome and toxicity of a short-course regimen of radiotherapy (RT) in selected metastatic spinal cord compression (MSCC) patients.  Between 1993 and 1995, 53 consecutive patients with MSCC from low radio-responsive primary tumors (non small cell lung, kidney, head and neck and gastrointestinal carcinomas, melanoma and sarcomas), or more radio-responsive ones (breast and prostate carcinomas, myeloma and lymphomas) with paresis, plegia, low performance status (PS ECOG > or = 2), and/or short life expectation, underwent short-course RT; a single fraction of 8 Gy repeated after 1 week in responders or stable patients, for a total dose of 16 Gy.  Of 49 (92%) evaluable cases, 4 (8%) underwent surgery plus RT and the other 45 RT alone.  Medium doses of parenteral dexamethasone (8 mg x 2/d) were given in all cases and precautional anti-emetics to those treated with fields covering the upper abdomen (20 of 49 cases).  Median follow up was 25 months (range, 6-34).  Response was assessed according to back pain, and motor and bladder capacity before and after RT.  Pain relief was achieved in 67% of patients and motor function response rate reached 63%.  Early diagnosis and therapy were very important in predicting response to RT; all but two (91%) pretreatment walking patients and all but one (98%) with good bladder function preserved these capacities.  On the contrary, when diagnosis was late, only 38% of nonambulatory patients and 44% of those with bladder retention improved.  Median survival was 5 months, with a 30% probability of survival for 1 year.  Length of survival was significantly longer for patients able to walk before and/or after RT.  Good agreement between survival and duration of response was found with no evidence of relapse in the irradiated spine.  Sickness appeared only in a few cases.  Slight esophagitis was more frequent: dysphagia for solid foods in one-third of patients irradiated on the thoracic spine.  Late toxicity was never recorded.  The short-course RT adopted gave a clinical outcome comparable with that resulting from more protracted regimens with only slight side effects.  The use of a few large treatment fractions could be explored considering the associated advantages for patients and radiotherapy centers often overloaded by long patient waiting lists.