ASCO 2017: Single-Dose Radiotherapy as Effective as Multiple Fractions in Relieving Symptoms of Spinal Cord Compression

Key Points

  • At 8 weeks, 69.5% of patients who received single-dose radiation therapy and 73.3% of those who received five doses had an ambulatory status of 1 to 2.
  • The median overall survival was similar in the two groups—12.4 weeks with a single dose vs 13.7 weeks with five doses.
  • The proportion of patients with severe side effects was similar in the two groups (20.6% vs 20.4%), but mild side effects were less common in the single-dose group (51% vs 57%). 

Spinal cord compression is a common complication in people with metastatic cancer and is a major detriment to quality of life. Radiation treatment is widely used to relieve pain and other symptoms, but there is no standard recommended schedule, and approaches currently vary. Findings from a phase III clinical trial show that a single radiation treatment may be as effective as a full week of radiation therapy. The study was presented today by Hoskin et al at the 2017 ASCO Annual Meeting (Abstract LBA10004).

“Our findings establish single-dose radiotherapy as the standard of care for metastatic spinal canal compression, at least for patients with a short life expectancy,” said lead study author Peter Hoskin, MD, FCRP, FRCR, an oncologist at the Mount Vernon Cancer Centre in Middlesex, United Kingdom. “For patients, this means fewer hospital visits and more time with family.”

When cancer spreads to the bones, it most commonly affects the spine. Tumors in the spine can put pressure on the spinal canal, causing back pain, numbness, tingling, and difficulty walking. Many patients with advanced solid tumors develop bone metastases, and up to 10% of all patients with cancer will have metastatic spinal cord compression.

About the Study

The study enrolled 688 patients with metastatic prostate (44%), lung (18%), breast (11%), and gastrointestinal cancers (11%). The median age was 70 years, and 73% were male. The researchers randomly assigned patients to receive external-beam spinal canal radiation therapy either as a single dose of 8 Gy or as 20 Gy split in five doses over 5 days.

The primary endpoint of the study was ambulatory status, measured on a four-point scale:

Grade 1: Able to walk normally

Grade 2: Able to walk with a walking aid (such as a cane or walker)

Grade 3: Has difficulty walking even with walking aids

Grade 4: Dependent on wheelchair

At study entry, 66% of patients had an ambulatory status of 1 to 2.

Key Findings

At 8 weeks, 69.5% of patients who received single-dose radiation therapy and 73.3% of those who received five doses had an ambulatory status of 1 to 2, showing that both shorter- and longer-course radiation treatments helped patients stay mobile. The median overall survival was similar in the two groups—12.4 weeks with a single dose vs 13.7 weeks with five doses (the difference was not statistically significant).

The proportion of patients with severe side effects was similar in the two groups (20.6% vs 20.4%), but mild side effects were less common in the single-dose group (51% vs 56.9%).

Dr. Hoskin emphasized that early recognition and prompt treatment of spinal cord compression symptoms are critical to achieve the best results with radiation therapy.

Commentary

“Spinal cord compression is a debilitating condition that many patients with advanced cancer experience. Until now, patients often had to spend multiple days traveling back and forth to undergo radiation treatments. This study means that without compromising care, we can help patients have more time to focus on the things they enjoy instead of on the cancer,” said Joshua A. Jones, MD, MA, an ASCO expert.

This study was funded by Cancer Research UK.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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