Single radiation dose sufficient for spinal cord suppression relief
medwireNews: Multifraction radiotherapy is unnecessary for some patients with spinal cord compression symptoms in late-stage cancer, suggest SCORAD III study findings reported at the 2017 annual meeting of the American Society of Clinical Oncology in Chicago, Illinois, USA.
“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,” presenting author Peter Hoskin (Mount Vernon Cancer Centre, Middlesex, UK) said in a press statement.
“For patients, this means fewer hospital visits and more time with family.”
The phase III trial included 688 patients, aged a median of 70 years, with metastatic prostate, lung, breast, or gastrointestinal cancer. At baseline, 66% of patients had an ambulatory scale grade of 1 or 2, denoting the ability to walk normally or with an aid, while the remainder were classified as grade 3 or 4 indicating difficulty walking with an aid or reliance on a wheelchair.
At week 8, 69.5% of patients who were randomly assigned to receive a single 8-Gy dose of radiation had grade 1 or 2 ambulatory status, as did 73.3% of those who received 20 Gy given over 5 days.
Indeed, there was no significant difference between the two treatment arms with regard to the proportion of patients whose ambulatory status was maintained at grade 1–2, improved from grade 3–4 to 1–2, or deteriorated from grade 1–2 to 3–4.
Nor was there a significant difference between a single dose of radiation and multifraction radiation on bowel or bladder function.
“Early diagnosis is important for best outcomes”
These results show that “early diagnosis is important for best outcomes,” Hoskin told the press conference, noting that patients who arrive ambulant will retain their ambulation regardless of radiation regimen received.
The rate of grade 3–4 adverse events associated with treatment was comparable between the single and multifraction treatment groups, at 20.6% versus 20.4%, and grade 1–2 side effects were less common with a single dose, at 51.0% versus 56.9%.
Overall survival was also similar in the treatment groups, at a median of 12.4 and 13.7 weeks, respectively.
However, the presenting author observed that multifraction radiotherapy may reduce the likelihood of metastatic regrowth in the spine compared with a single dose.
“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,” Hoskin said.
“Sometimes less really is more”
Commenting on the findings for ASCO, Joshua Jones (University of Pennsylvania, Philadelphia, USA) said at the press conference that “this is the first study that really shows equal outcomes, in terms of meaningful benefits for patients, with a single dose of radiotherapy versus a much longer course.”
He concluded that for “many patients this is going to provide tremendous benefit with the idea that sometimes less really is more.”
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