Radiotherapy for malignant spinal cord compression - prognostic factors for better functional outcome

		N (%)
Gender	Female	101 (33.7)
Gender	Male	199 (66.3)
Age (years)	Median (range)	67 (22-91)
ECOG PS	1	24 (8.0)
	2	58 (19.3)
	3	139 (46.3)
	4	79 (26.3)
Primary tumor type	Lung cancer	88 (29.3)
	Prostate cancer	54 (18.0)
	Breast cancer	36 (12.0)
	Urothelial cancer	19 (6.3)
	Multiple myeloma	19 (6.3)
	Lymphoma	20 (6.7)
	Sarcoma	13 (4.3)
	Other^{^ꟸ}	51 (17.0)
MRI	Yes	211 (70.3)
MRI	No	86 (28.7)
Surgical evaluation	Yes	159 (53.0)
Surgical evaluation	No	141 (47.0)
Motoric deficit	Paresis	213 (71.0)
	Paralysis	27 (9.0)
	No motoric deficit	60 (20.0)
Pain	Yes	286 (95.3)
Pain	No	14 (5.7)
Sensory deficit	Yes	219 (70.0)
Sensory deficit	No	83 (27.7)
Sphincter dysfunction	Yes	97 (32.3)
Sphincter dysfunction	No	201 (67.0)
Further bone metastases	Yes	234 (78.0)
Further bone metastases	No	65 (21.7)
Visceral metastases	Yes	165 (55.0)
Visceral metastases	No	133 (44.3)
Brain metastases	Yes	37 (12.3)
Brain metastases	No	263 (87.7)
Affected spinal level^*	Cervical	40
	Thoracic	191
	Lumbar	123
	Sacral	37
Number of affected vertebrae	1-2	192 (64.0)
	3-5	47 (24.7)
	≥ 5	34 (11.3)
Level of MSCC	One level	245 (81.7)
Level of MSCC	Multiple levels	55 (18.3)
RT technique	2D	184 (61.3)
	3D CRT	83 (27.7)
	IMRT/VMAT	31 (11.0)
Time to RT in 48h after MSCC onset	No	238 (79.3)
Time to RT in 48h after MSCC onset	Yes	62 (20.7)

2D = two dimensional; 3D CRT = three dimensional conformal radiotherapy; ECOG PS = Eastern Cooperative Oncology Group performance status; h = hour; IMRT = intensity modulated radiotherapy; MRI = magnetic resonance imaging; MSCC = malignant spinal cord compression; N = number; RT = radiotherapy; VMAT = volumetric arc therapy

ꟸ Other: Unknown primary (N = 10), colorectal (N = 12), skin (N = 11), head and neck (N = 5), gynecological (N = 2), liver (N = 2), esophageal (N = 2), stomach (N = 5), thyroid (N = 1) and testicular cancer (N = 1). Unknown data is counted as missing value.

* Patients with two (three, four) spinal levels are counted twice (three, four times)

TABLE 2.

Treatment outcomes after radiotherapy for MSCC

		N (%)
Status	Alive	22 (7.3)
Status	Dead	278 (92.7)
Treatment outcome	No change	155 (51.7)
	Functional improvement	96 (32.0)
	Functional deterioration	17 (5.7)
	Cannot be assessed	32 (10.7)
Improvement in neurological function after RT	No	204 (68%)
Improvement in neurological function after RT	Yes	96 (32%)
Survival > 1 month	No	109 (36.3)
Survival > 1 month	Yes	190 (63.3)
Effective Treatment^*	Yes	134 (44.7)
Effective Treatment^*	No	166 (55.3)

MSCC = malignant spinal cord compression; N = number; RT = radiotherapy

* see definition in Materials and methods section

TABLE 3.

Univariate and multivariate logistic regression analysis of prognostic factors affecting functional outcome after radiotherapy for MSCC

Factor	Univariate analysis			Multivariate analysis
	Subgroup (N)	Effective treatment N (%)	p-value	OR (95% CI)	p-value
ECOG PS	1-2 (82) 3-4 (218)	66 (80.5) 68 (31.2)	< 0.001	0.109 (0.054-0.0219)	< 0.001
Gender	Female (101) Male (199)	49 (48.5) 85 (42.7)	0.340	Not included in MVA
Primary tumor type	Lung cancer (88) Prostate cancer (54) Breast cancer (36) Myeloma/lymphoma (39) Other (83)	29 (33.0) 25 (46.3) 19 (52.8) 31 (79.5) 30 (36.1)	< 0.001	9.257 (3.157-27.146)	NS NS NS < 0.001 NS
Neurological examination	Yes (159) No (141)	66 (41.5) 68 (48.2	0.234	Not included in MVA
MRI	Yes (211) No (86)	103 (48.8) 30 (34.9)	0.029	2.142 (1.086-4.226)	0.028
Surgical evaluation	Yes (159) No (141)	70 (44.0) 64 (45.4)	0.812	Not included in MVA
Motor deficit	Paresis (213) Paralysis (27) No (60)	101 (47.4) 3 (11.1) 30 (50.0)	0.001	0.168 (0.086-0.786)	0.024
Sensory deficit	Yes (210) No (83)	86 (41.0) 44 (53.0)	0.093	Not included in MVA
Sphincter dysfunction	Yes (97) No (201)	32 (67.0) 102 (50.7)	0.004		NS
Pain	Yes (286) No (14)	129 (45.1) 5 (35,7)	0.490	Not included in MVA
Further bone metastases	Yes (234) No (65)	105 (44.9) 29 (44.6)	0.667	Not included in MVA
Visceral metastases	Yes (165) No (133)	71 (43.0) 63 (47.4)	0.335	Not included in MVA
CNS metastases	Yes (37) No (263)	19 (51.4) 115 (43.7)	0.382	Not included in MVA
No. of affected vertebrae	1-2 (192) ≥ 3 (108	81 (42.2) 53 (49.1)	0.249	Not included in MVA
RT technique	2D (184) 3D (83) IMRT/VMAT (31)	74 (40.2) 45 (54.2) 15 (45.5)	0.103	Not included in MVA
Total RT dose EQD2 (EQD₂ α/β = 10)	< 31,25Gy (233) ≥ 31,25Gy (67)	95 (40.8) 39 (58.2)	0.011		NS
Age (years)	≤ 65 (139) > 65 (161)	60 (43.2) 74 (46.0)	0.627	Not included in MVA
Time from neurologic deficit to RT (days)	≤ 2 (62) > 2 (238)	22 (35.5) 112 (52.9)	0.102	Not included in MVA
Time from neurologic deficit to RT (days)	0-7 (132) 8-14 (75) > 14 (93)	57 (43.2) 31 (41.3) 46 (49.5)	0.517	Not included in MVA
Interval from diagnosis to MSCC (months)	≤ 15 (186) > 15 (114)	74 (39.8) 60 (52.6)	0.030		NS

[i] 2D = two dimensional; 3D CRT = three dimensional conformal radiotherapy; CI = confidence interval; CNS = central nervous system; ECOG PS = Eastern Cooperative Oncology Group performance status; EQD2 = equivalent dose in 2Gy fractions; IMRT = intensity modulated radiotherapy; MRI = magnetic resonance imaging; MSCC = malignant spinal cord compression; MVA = multivariate analysis; N = number; NS = non significant; OR = odds ratio; RT = radiotherapy; VMAT = volumetric arc therapy

[ii] Prognostic factors that retained significance in multivariate logistic regression analysis are shown in bold letters.

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DOI: https://doi.org/10.2478/raon-2026-0013 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 132 - 140

Submitted on: Feb 12, 2026

Accepted on: Feb 19, 2026

Published on: Mar 24, 2026

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

malignant spinal cord compression,

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© 2026 Jasna But-Hadzic, Blaz Groselj, Dirk Rades, Barbara Segedin, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 60 (2026): Issue 1 (March 2026)