Cochrane · systematic review · CD006716
Interventions for the treatment of metastatic extradural spinal cord compression in adults
George, R, Sundararaj, JJ, Govindaraj, R, et al. · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library
Pain, Palliative and Supportive CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
23
No studies
8
Included studies
NR
No studies 8 · 22.9%Ungraded 4 · 11.4%Very low 4 · 11.4%Low 8 · 22.9%Moderate 11 · 31.4%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Single‐fraction radiotherapy (8 Gy) compared to short‐course radiotherapy (16 Gy in two fractions) for adults with metastatic extradural spinal cord compression
Population: adults with metastatic extradural spinal cord compression (poor prognosis with visceral metastasis, and no spinal instability or bony impingement of cord)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ambulation One month after radiation Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy | RR 0.93 [0.82, 1.04] | 1 study · 303 participants | Moderate Downgraded: imprecision, indirectness |
Survival Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy | no estimate extracted | 0 studies · 1 participants | Moderate Downgraded: imprecision, indirectness |
Reduction in analgesic and narcotic use One month after radiation Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy | RR 0.85 [0.62, 1.16] | 1 study · 271 participants | Moderate Downgraded: imprecision, indirectness |
Urinary continence One month after radiation Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy | RR 1.03 [0.96, 1.1] | 1 study · 303 participants | Moderate Downgraded: imprecision, indirectness |
Local recurrence MRI: Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy | RR 2.21 [0.69, 7.01] | 1 study · 303 participants | Low Downgraded: imprecision, indirectness |
Adverse events Grade 3 oesophagitis, diarrhoea and nausea Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy | RR 0.14 [0.01, 2.69] | 1 study · 303 participants | Moderate Downgraded: imprecision |
Quality of life Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy | no estimate extracted | NR | No studies |
Split‐course radiotherapy (8 fractions, 30 Gy) compared to short‐course radiotherapy (2 fractions, 16 Gy) for adults with metastatic extradural spinal cord compression
Population: adults with metastatic extradural spinal cord compression (poor prognosis, no spinal instability or bony impingement of cord)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ambulation One month after treatment Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (2 fractions, 16 Gy) | RR 1.02 [0.9, 1.15] | 1 study · 276 participants | Moderate Downgraded: imprecision, indirectness |
Survival Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (2 fractions, 16 Gy) | no estimate extracted | 0 studies · 1 participants | Moderate Downgraded: imprecision, indirectness |
Reduction in analgesic and narcotic use One month after radiation Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (2 fractions, 16 Gy) | RR 1.27 [0.96, 1.67] | 1 study · 262 participants | Moderate Downgraded: imprecision, indirectness |
Urinary continence One month after radiation Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (2 fractions, 16 Gy) | RR 0.97 [0.93, 1.02] | 1 study · 275 participants | Moderate Downgraded: imprecision, indirectness |
Local recurrence Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (2 fractions, 16 Gy) | RR 0.1 [0.01, 1.72] | 1 study · 276 participants | Low Downgraded: imprecision, indirectness |
Adverse events Grade 3 oesophagitis, diarrhoea, and nausea Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (2 fractions, 16 Gy) | RR 1.77 [0.43, 7.25] | 1 study · 276 participants | Moderate Downgraded: imprecision |
Quality of life Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (2 fractions, 16 Gy) | no estimate extracted | NR | No studies |
Laminectomy plus radiotherapy compared to radiotherapy for adults with metastatic extradural spinal cord compression
Population: adults with metastatic extradural spinal cord compression (single lesion, no prior radiotherapy, fit for surgery)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ambulation At four months Laminectomy plus radiotherapy vs radiotherapy | RR 0.98 [0.38, 2.48] | 1 study · 29 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Survival At four months Laminectomy plus radiotherapy vs radiotherapy | RR 1.22 [0.59, 2.53] | 1 study · 29 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction in analgesic use Laminectomy plus radiotherapy vs radiotherapy | RR 0.88 [0.42, 1.81] | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Urinary continence One month after treatment Laminectomy plus radiotherapy vs radiotherapy | RR 1.06 [0.57, 2] | 1 study · 29 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Local recurrence Laminectomy plus radiotherapy vs radiotherapy | no estimate extracted | NR | No studies |
Adverse events Laminectomy plus radiotherapy vs radiotherapy | no estimate extracted | 1 study · 29 participants | Ungraded |
Quality of life Laminectomy plus radiotherapy vs radiotherapy | no estimate extracted | NR | No studies |
Decompressive surgery plus radiotherapy compared to radiotherapy for adults with metastatic extradural spinal cord compression
Population: adults with metastatic extradural spinal cord compression (fit for surgery, paraplegic less than 48 hours, and without multiple discrete compressions or radiosensitive tumours; with cervical or thoracic lesions, and life expectancy three months or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ambulation Immediately after completing RT Decompressive surgery plus radiotherapy vs radiotherapy | RR 1.48 [1.16, 1.9] | 1 study · 101 participants | Low Downgraded: imprecision, indirectness |
Survival (short term) At 30 days Decompressive surgery plus radiotherapy vs radiotherapy | RR 1.09 [0.96, 1.24] | 1 study · 101 participants | Low Downgraded: imprecision, indirectness |
Reduction in analgesic and narcotic use Decompressive surgery plus radiotherapy vs radiotherapy | no estimate extracted | 1 study · 101 participants | Ungraded |
Urinary continence Decompressive surgery plus radiotherapy vs radiotherapy | no estimate extracted | 1 study · 101 participants | Ungraded |
Local recurrence Decompressive surgery plus radiotherapy vs radiotherapy | no estimate extracted | NR | No studies |
Adverse events Decompressive surgery plus radiotherapy vs radiotherapy | no estimate extracted | 1 study · 101 participants | Ungraded |
Quality of life Decompressive surgery plus radiotherapy vs radiotherapy | no estimate extracted | NR | No studies |
High‐dose corticosteroids compared to moderate‐dose or no corticosteroids for adults with metastatic extradural spinal cord compression
Population: adults with metastatic extradural spinal cord compression (without peptic ulceration or infection; mixed prognosis)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Ambulation High‐dose corticosteroids vs moderate‐dose or no corticosteroids | RR 1.08 [0.81, 1.45] | 3 studies · 105 participants | Low Downgraded: imprecision |
Survival (long term) Over two years High‐dose corticosteroids vs moderate‐dose or no corticosteroids | RR 1.11 [0.24, 5.05] | 1 study · 57 participants | Low Downgraded: imprecision |
Pain reduction High‐dose corticosteroids vs moderate‐dose or no corticosteroids | RR 0.86 [0.62, 1.2] | 1 study · 25 participants | Low Downgraded: imprecision |
Urinary continence One week after treatment High‐dose corticosteroids vs moderate‐dose or no corticosteroids | RR 1.18 [0.66, 2.13] | 1 study · 34 participants | Low Downgraded: imprecision |
Local recurrence ‐ High‐dose corticosteroids vs moderate‐dose or no corticosteroids | no estimate extracted | NR | No studies |
Serious adverse events High‐dose corticosteroids vs moderate‐dose or no corticosteroids | RR 8.02 [1.03, 62.37] | 2 studies · 77 participants | Moderate Downgraded: imprecision |
Quality of life High‐dose corticosteroids vs moderate‐dose or no corticosteroids | no estimate extracted | NR | No studies |