Radiation therapy of metastatic spinal cord compression. Multidisciplinary team diagnosis and treatment.

PURPOSE: To evaluate the effectiveness of a multidisciplinary approach to spinal cord compression (SCC) in accordance with prospective protocol, providing a uniform approach to diagnosis, decision making concerning optimal treatment modality in any particular case of SCC, treatment performance and evaluation of treatment results. The SCC patients treated by radiation therapy are described. MATERIALS AND METHODS: Patients with SCC were examined and treated by a multidisciplinary team consisting of a neurologist, radiologist, oncologist, orthopedic surgeon, and neurosurgeon. Seventy-nine patients for whom radiation was recommended received a 30 Gy radiation dose to a compression-causing mass and course of high dose dexamethasone. Three fractions of 5 Gy and 5 fractions 3 Gy each were delivered by Co60 or 8 MV photon beam in 12 days. Treatment outcome was essentially evaluated by ambulation capabilities which were considered to be the main problem of SCC. Changes in other neurologic motor, sensory and autonomic disturbances were also evaluated. RESULTS: Seventy-two percent of the patients were already non-ambulatory at diagnosis. The first symptom was motor deficiency in only 33% of them while in all other cases it was pain. Ambulation capability was the main prognosticator of treatment outcome; 90% of patients who were ambulatory before treatment remained so while 33% of the non-ambulatory patients regained their ability to walk. The grade of motor disturbance was also an important variable: among the non-ambulatory patients, 50% of the paretic but only 14% of the plegic ones became ambulatory. Overall, 51% of the study patients were ambulatory after undergoing radiation. The ambulatory state after treatment was the main predictor for survival. CONCLUSION: Close cooperation of a multidisciplinary team in diagnosis and treatment according to the above protocol enabled the achievement of good results of radiation treatment in SCC. Early diagnosis and early treatment should further enhance therapeutic outcome.

Sibling similarity in development of covariation among physical traits in early childhood.

We studied the sibling similarity in development of covariation among body size characters (body weight (W), body length (S) and head circumference (HC) in Tel Aviv infants from birth up to 2 years of age. We investigated the effects of parental geographic origin, profession, age, current residence, and of family size. Multiple regression analysis with "dummy" procedure established that none of these variables had any significant effect on the aforementioned anthropometric traits. The matrices of phenotypic and genetic correlations, based on sibling similarity data, among age-specific W, S, and HC (measured for 12 different ages) were subjected to principal component analysis in order to elucidate patterns over the age groups. The patterns of both analyses, phenotypic and genetic, were quite similar: one factor in each (first genetic and second phenotypic) had a high positive correlation with early, first 2-3 months of life, W, S, and HC. Three other extracted factors correlated strongly, each with late W, S, and HC, respectively. The results of additional principal component analyses of age-specific W, S, and HC matrices separately, indicate the possibility of existence of two genetic subsystems, the first determining early postnatal stages of human ontogeny, and the second, later phases of child development.