A single radiation treatment is as effective as a full week of radiation in relieving spinal cord compression in patients with metastatic cancer.
Lead author Peter Hoskin, MD, FCRP, FRCR, an oncologist at the Mount Vernon Cancer Centre in Middlesex, UK, reported the SCORAD phase III trial findings at the 2017 American Society of Clinical Oncology (ASCO) annual meeting. “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,” Dr Hoskin said in an ASCO news release. “For patients, this means fewer hospital visits and more time with family.”
For the trial, investigators randomly assigned 688 patients with cancer metastases (median age 70 years) from 43 centers in the United Kingdom and 4 in Australia to undergo external beam spinal canal radiation therapy at a single dose of 8Gy (345 patients) or 5 fractions totaling 20Gy (343 patients). Of the 688 patients, 44% had prostate cancer, 18 had lung cancer, 11% had breast cancer, and 11% had gastrointestinal cancer.
The single radiation dose proved as effective as multiple fractions over 8 weeks. At study entry, 66% of patients overall could walk normally on their own or with a walking aid. By the last week, 69.5% of single dose and 73.3% of multifraction patients maintained or improved to those levels of mobility.
Both groups had similar overall survival: 12.4 vs 13.7 weeks for single dose vs multifraction recipients.
Severe grade 3 to 4 adverse events occurred in the same proportion of patients (20.6% single dose vs 20.4% multifraction). Single dose recipients had fewer mild grade 1 to 2 events (51.0% vs 56.9%).
“Longer radiation may be more effective for preventing regrowth of metastases in the spine than single-dose radiation. Therefore, a longer course of radiation may still be better for patients with a longer life expectancy, but we need more research to confirm this,” Dr Hoskin said.
For certain patients, surgery may be recommended as an alternative or adjunct to radiation.
1. Hoskin P, Misra V, Hopkins K, et al. SCORAD III: Randomized noninferiority phase III trial of single-dose radiotherapy (RT) compared to multifraction RT in patients (pts) with metastatic spinal canal compression (SCC). J Clin Oncol 2017;35 (suppl; abstr LBA10004). Data presented at the 2017 American Society of Clinical Oncology annual meeting in Chicago on June 2.
2. A Single Radiation Treatment Sufficiently Relieves Spinal Cord Compression Symptoms. American Society of Clinical Oncology (ASCO). June 2, 2017 [news release]