Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

592 questions · 604 findings · 53 reviews · Headline outcomes only

No studies found 151 · 25%GRADE not reported 31 · 5.1%Very low 94 · 15.6%Low 170 · 28.1%Moderate 114 · 18.9%High 44 · 7.3%

Decompressive surgery plus radiotherapy vs radiotherapy

Ambulation · adults with metastatic extradural spinal cord compression (fit for surgery, paraplegic less than 48 hours, and without multiple discrete…

Decompressive surgery plus radiotherapy may leads to higher ambulation Immediately after completing RT compared with radiotherapy (low certainty).

1 finding from 1 review

Decompressive surgery plus radiotherapy vs radiotherapy

Survival (short term) At 30 days · adults with metastatic extradural spinal cord compression (fit for surgery, paraplegic less than 48 hours, and without multiple discrete…

Decompressive surgery plus radiotherapy showed no clear difference in survival (short term) At 30 days compared with radiotherapy (low certainty).

1 finding from 1 review

Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (16 Gy

Reduction in analgesic and narcotic use One month after radiation · adults with metastatic extradural spinal cord compression (poor prognosis, no spinal instability or bony impingement of cord)

Split‐course radiotherapy (8 fractions, 30 Gy) showed no clear difference in reduction in analgesic and narcotic use One month after radiation compared with short‐course radiotherapy (2 fractions, 16 Gy) (moderate certainty).

1 finding from 1 review

Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (16 Gy

Urinary continence One month after radiation · adults with metastatic extradural spinal cord compression (poor prognosis, no spinal instability or bony impingement of cord)

Split‐course radiotherapy (8 fractions, 30 Gy) showed no clear difference in urinary continence One month after radiation compared with short‐course radiotherapy (2 fractions, 16 Gy) (moderate certainty).

1 finding from 1 review

Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (16 Gy

Local recurrence · adults with metastatic extradural spinal cord compression (poor prognosis, no spinal instability or bony impingement of cord)

Split‐course radiotherapy (8 fractions, 30 Gy) showed no clear difference in local recurrence compared with short‐course radiotherapy (2 fractions, 16 Gy) (low certainty).

1 finding from 1 review

Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (16 Gy

Adverse events Grade 3 oesophagitis, diarrhoea and nausea · adults with metastatic extradural spinal cord compression (poor prognosis, no spinal instability or bony impingement of cord)

Split‐course radiotherapy (8 fractions, 30 Gy) showed no clear difference in adverse events Grade 3 oesophagitis, diarrhoea, and nausea compared with short‐course radiotherapy (2 fractions, 16 Gy) (moderate certainty).

1 finding from 1 review

Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (16 Gy

Ambulation · adults with metastatic extradural spinal cord compression (poor prognosis, no spinal instability or bony impingement of cord)

Split‐course radiotherapy (8 fractions, 30 Gy) showed no clear difference in ambulation One month after treatment compared with short‐course radiotherapy (2 fractions, 16 Gy) (moderate certainty).

1 finding from 1 review