Radiation Therapy for Spinal Cord Compression: One Treatment Is Sufficient


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“We now recommend using a single dose of radiotherapy in this setting, … requiring only a single instead of multiple hospital visits. This is important when considering the short survival of these patients.”
— Peter Hoskin, MD

SPINAL CORD COMPRESSION associated with metastatic cancer can be effectively treated with a single dose of radiotherapy, according to the results of a phase III British study that showed multiple radiotherapy doses to be no better than one treatment.1 

Up to 10% of all patients with cancer will develop metastatic spinal cord compression. There has been no standard recommended schedule, and approaches have varied. 

The informative data from the SCORAD III trial were presented at the 2017 ASCO Annual Meeting by Peter Hoskin, MD, of the Mount Vernon Cancer Centre in Middlesex, United Kingdom, who concluded, “We now recommend using a single dose of radiotherapy in this setting, with the major benefit of requiring only a single instead of multiple hospital visits. This is important when considering the short survival of these patients.” 

SCORAD III Details 

THE STUDY enrolled 688 patients with metastatic prostate (44%), lung (18%), breast (11%), or gastrointestinal cancer (11%) and previously untreated spinal cord or cauda equina (C1–S2) compression. The median age was 70 years, and 73% of patients were male. At study entry, two-thirds of patients were able to walk normally or with a walking aid. Patients were randomized to receive external-beam spinal canal radiation therapy either as a single dose of 8 Gy or as 20 Gy delivered in 5 fractions over 5 days. 

SCORAD III, which had a noninferiority design, met its primary endpoint, which was to show no difference in ambulatory status at week 8, graded as 1 (full function) to 4 (dependent on wheelchair) with a single treatment. The use of a single dose of 8 Gy was as effective as multiple fractions in terms of ambulatory status and also overall survival, Dr. Hoskin reported. 

Key Findings 

AT 8 WEEKS, no statistically significant differences were noted in the following outcomes: 

  • Ambulatory status grade 1–2: 69.5% with single-dose radiation therapy and 73.3% with 5 doses 
  • Improvement from grade 3–4 status to grade 1–2: 7.3% and 10.2%, respectively 
  • Worsening from grade 1–2 status to grade 3–4: 16.5% and 12.5%, respectively 
  • Median overall survival: 12.4 weeks and 13.7 weeks, respectively. 
  • Grade 3/4 adverse events: 20.6% and 20.4%, respectively 
  • Grade 1/2 adverse events: 51% vs 56.9%, respectively. 

Dr. Hoskin noted that “almost 70% of patients returned to ambulation,” which is “an enormous advantage for patients with short survival.” He added that early diagnosis is important in preventing or reversing the worsening of this condition. ■

DISCLOSURE: Dr. Hoskin reported no conflicts of interest. 

REFERENCE 

1. Hoskin P, Misra V, Hopkins K, et al: SCORAD III: Randomised non-inferiority phase III trial of single dose radiotherapy compared to multifraction radiotherapy in patients with metastatic spinal canal compression. 2017 ASCO Annual Meeting. Abstract LBA10004. Presented June 2, 2017.


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