Many patients with malignant spinal cord compression (MSCC) who are not candidates for neurosurgery receive radiotherapy alone. This study compared 15 × 2.633 Gy over three weeks to 20 × 2.0 Gy over four weeks in patients with favorable survival prognoses. The outcomes of 34 patients treated with 15 × 2.633 Gy (equivalent dose 41.6 Gy10) in the RAMSES-01 trial were compared to 239 patients from an existing database receiving 20 × 2.0 Gy using propensity-score-adjusted Cox and logistic regression models. All patients had favorable survival prognoses. Endpoints included local progression-free survival (LPFS), improvement of motor function, post-treatment ambulatory status, and overall survival (OS). After propensity score adjustment, the 12-month rates of LPFS and OS were 98.1% (RAMSES-01 cohort) vs. 91.6% (p= 0.265) and 79.1% vs. 82.2% (p= 0.704), respectively. Regarding improvement of motor function, 15 × 2.633 Gy appeared superior (p= 0.073). No significant difference was observed regarding ambulatory status (p= 0.822). The three-week regimen for MSCC has similar outcomes and reduces treatment time when compared to a four-week regimen.
许多不适合神经外科手术的恶性脊髓压迫患者仅接受放射治疗。本研究针对生存预后良好的患者，比较了三周内15次×2.633 Gy与四周内20次×2.0 Gy两种放疗方案的效果。通过倾向评分校正的Cox回归和逻辑回归模型，将RAMSES-01试验中接受15×2.633 Gy（等效剂量41.6 Gy10）治疗的34例患者，与现有数据库中接受20×2.0 Gy治疗的239例患者进行对比。所有患者均具有良好生存预后。观察终点包括局部无进展生存期、运动功能改善、治疗后行走能力及总生存期。经倾向评分校正后，12个月局部无进展生存率分别为98.1%（RAMSES-01队列）对91.6%（p=0.265），总生存率分别为79.1%对82.2%（p=0.704）。在运动功能改善方面，15×2.633 Gy方案显示出更优趋势（p=0.073）。两组在行走能力方面无显著差异（p=0.822）。对于恶性脊髓压迫患者，三周放疗方案与四周方案疗效相当，且能缩短治疗时间。
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