scholarly journals Comparison of 5 × 5 Gy and 10 × 3 Gy for metastatic spinal cord compression using data from three prospective trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dirk Rades ◽  
Jon Cacicedo ◽  
Antonio J. Conde-Moreno ◽  
Barbara Segedin ◽  
Darejan Lomidze ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Function ◽  
Spinal Cord Compression ◽  
Treatment Time ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Motor Deficits ◽  
Tumor Type ◽  
Ambulatory Status ◽  
Local Progression

Abstract Background In a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radiotherapy should be as short as possible. This study compared 5 × 5 Gy in 1 week to 10 × 3 Gy in 2 weeks in a prospective cohort. Methods Forty patients receiving 5 × 5 Gy in a phase II trial were matched 1:2 to 213 patients receiving 10 × 3 Gy in two previous prospective studies for tumor type, ambulatory status, time developing motor deficits, interval between tumor diagnosis and MSCC and visceral metastases. These factors were consistent in all three patients (triple) used for each 1:2 matching. Groups were compared for local progression-free survival (LPFS), motor function, ambulatory status, and overall survival (OS). Results After matching, 32 triples remained for analyses (N = 96 in total). Six-month LPFS-rates were 94% after 5 × 5 Gy and 87% after 10 × 3 Gy (p = 0.36), 6-month OS-rates 43% and 35% (p = 0.74). Improvement of motor function was achieved in 59% and 34% of patients (p = 0.028); overall response rates (improvement or no further progression of motor deficits) were 94% and 89% (p = 0.71). Post-treatment ambulatory rates were 81% after 5 × 5 Gy and 85% after 10 × 3 Gy (p = 0.61). Of non-ambulatory patients, 50% (6/12) and 46% (11/24) regained the ability to walk (p = 1.00). Conclusions 5 × 5 Gy in 1 week appeared similarly effective as 10 × 3 Gy in 2 weeks. These results may not be applicable to long-term survivors and should be confirmed in a randomized trial directly comparing 5 × 5 Gy and 10 × 3 Gy. Trial registration clinicaltrials.gov NCT03070431. Registered 27 February 2017.

Radiotherapy With 4 Gy × 5 Versus 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression: Final Results of the SCORE-2 Trial (ARO 2009/01)

2016 ◽  
Vol 34 (6) ◽  
pp. 597-602 ◽  
Author(s):  
Dirk Rades ◽  
Barbara Šegedin ◽  
Antonio J. Conde-Moreno ◽  
Raquel Garcia ◽  
Ana Perpar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Motor Function ◽  
Progression Free Survival ◽  
Cord Compression ◽  
Motor Deficits ◽  
Free Survival ◽  
Ambulatory Status ◽  
Local Progression ◽  
Short Course

Purpose To compare short-course radiotherapy (RT) (4 Gy × 5) to longer-course RT (3 Gy × 10) for metastatic epidural spinal cord compression (MESCC). Patients and Methods Two-hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy × 5 in 1 week (n = 101) or 3 Gy × 10 in 2 weeks (n = 102). Patients were stratified according to ambulatory status, time developing motor deficits, and primary tumor type. Seventy-eight and 77 patients, respectively, were evaluable for the primary end point, 1-month overall response regarding motor function defined as improvement or no further progression of motor deficits. Other study end points included ambulatory status, local progression-free survival, and overall survival. End points were evaluated immediately after RT and at 1, 3, and 6 months thereafter. Results At 1 month, overall response rates regarding motor function were 87.2% after 4 Gy × 5 and 89.6% after 3 Gy × 10 (P = .73). Improvement rates were 38.5% and 44.2%, respectively, no further progression rates 48.7% and 45.5%, respectively, and deterioration rates 12.8% and 10.4%, respectively (P = .44). Ambulatory rates at 1 month were 71.8% and 74.0%, respectively (P = .86). At other times after RT, the results were also not significantly different. Six-month local progression-free survival was 75.2% after 4 Gy × 5 and 81.8% after 3 Gy × 10 (P = .51); 6-month overall survival was 42.3% and 37.8% (P = .68). Conclusion Short-course RT with 4 Gy × 5 was not significantly inferior to 3 Gy × 10 in patients with MESCC and poor to intermediate expected survival.

Outcome After Radiotherapy Alone for Metastatic Spinal Cord Compression in Patients With Oligometastases

2007 ◽  
Vol 26 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Dirk Rades ◽  
Theo Veninga ◽  
Lukas J.A. Stalpers ◽  
Hiba Basic ◽  
Volker Rudat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Local Control ◽  
Cord Compression ◽  
Motor Deficits ◽  
Tumor Type ◽  
Ambulatory Status ◽  
Oligometastatic Disease ◽  
Radiotherapy Alone ◽  
Long Course

Purpose To investigate outcome and prognosis of metastatic spinal cord compression (MSCC) patients with oligometastatic disease treated with radiotherapy alone. Patients and Methods Oligometastatic disease was defined as involvement of three or fewer vertebrae and lack of other bone or visceral metastases. Five hundred twenty-one patients with oligometastatic disease and MSCC were evaluated for functional outcome, ambulatory status, local control of MSCC, and survival. Furthermore, seven potential prognostic factors were investigated. Results Motor function improved in 40% (n = 207), remained stable in 54% (n = 279), and deteriorated in 7% (n = 35) of patients. Fifty-eight (54%) of 107 nonambulatory patients became ambulatory, and 388 (94%) of 414 ambulatory patients remained ambulatory. Improved functional outcome was significantly associated with tumor type and slower development of motor deficits (> 14 days). Local control at 1, 2, and 3 years was 92%, 88%, and 78%, respectively. Improved local control was significantly associated with long-course radiotherapy. Survival at 1, 2, and 3 years was 71%, 58%, and 50%, respectively. Better survival was significantly associated with tumor type, ambulatory status, slower development of motor deficits, and long-course radiotherapy. Patients who developed motor deficits slowly (onset > 14 days before initiating treatment) were further analyzed. In this subgroup, the best results were observed for myeloma/lymphoma and breast cancer patients. No patient had progression of motor deficits. One hundred percent (myeloma/lymphoma) and 99% (breast cancer) of patients were ambulatory after radiotherapy. One-year local control was 100% and 98%, 1-year survival was 94% and 89%. Conclusion Given the limitations of a retrospective review, improved outcome of patients with oligometastatic MSCC was associated with myeloma/lymphoma and breast cancer, slower development of motor deficits, and a more prolonged course of radiation.

Evaluation of Five Radiation Schedules and Prognostic Factors for Metastatic Spinal Cord Compression

2005 ◽  
Vol 23 (15) ◽  
pp. 3366-3375 ◽  
Author(s):  
Dirk Rades ◽  
Lukas J.A. Stalpers ◽  
Theo Veninga ◽  
Rainer Schulte ◽  
Peter J. Hoskin ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Functional Outcome ◽  
Motor Function ◽  
Cancer Diagnosis ◽  
Performance Status ◽  
Cord Compression ◽  
Motor Deficits ◽  
Ambulatory Status

Purpose To study five radiotherapy (RT) schedules and potential prognostic factors for functional outcome in metastatic spinal cord compression (MSCC). Patients and Methods One thousand three hundred four patients who were irradiated from January 1992 to December 2003 were included in this retrospective review. The schedules of 1 × 8 Gy in 1 day (n = 261), 5 × 4 Gy in 1 week (n = 279), 10 × 3 Gy in 2 weeks (n = 274), 15 × 2.5 Gy in 3 weeks (n = 233), and 20 × 2 Gy in 4 weeks (n = 257) were compared for motor function, ambulatory status, and in-field recurrences. The following potential prognostic factors were investigated: age, sex, performance status, histology, number of involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits before RT. A multivariate analysis was performed with the ordered logit model. Results Motor function improved in 26% (1 × 8 Gy), 28% (5 × 4 Gy), 27% (10 × 3 Gy), 31% (15 × 2.5 Gy), and 28% (20 × 2 Gy); and posttreatment ambulatory rates were 69%, 68%, 63%, 66%, and 74% (P = .578), respectively. On multivariate analysis, age, performance status, primary tumor, involved vertebra, interval from cancer diagnosis to MSCC, pretreatment ambulatory status, and time of developing motor deficits were significantly associated with functional outcome, whereas the RT schedule was not. Acute toxicity was mild, and late toxicity was not observed. In-field recurrence rates at 2 years were 24% (1 × 8 Gy), 26% (5 × 4 Gy), 14% (10 × 3 Gy), 9% (15 × 2.5 Gy), and 7% (20 × 2 Gy) (P < .001). Neither the difference between 1 × 8 Gy and 5 × 4 Gy (P = .44) nor between 10 × 3 Gy, 15 × 2.5 Gy, and 20 × 2 Gy (P = .71) was significant. Conclusion The five RT schedules provided similar functional outcome. The three more protracted schedules seemed to result in fewer in-field recurrences. To minimize treatment time, the following two schedules are recommended: 1 × 8 Gy for patients with poor predicted survival and 10 × 3 Gy for other patients. Results should be confirmed in a prospective randomized trial.

Local Control of Metastatic Spinal Cord Compression Following Radiotherapy

2010 ◽  
Vol 06 (01) ◽  
pp. 24
Author(s):  
Dirk Rades ◽  
Steven E Schild ◽  
◽  
Keyword(s):  
Spinal Cord ◽  
Local Control ◽  
Spinal Cord Compression ◽  
Treatment Time ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Considerable Proportion ◽  
Survival Prognosis ◽  
Short Course ◽  
Long Course

Radiotherapy (RT) alone is the most frequently applied treatment modality for metastatic spinal cord compression (MSCC). Short-course RT (overall treatment time one week or less) provides a similar functional outcome to longer programmes. Therefore, short-course RT should be seriously considered for many MSCC patients, especially for those with a poor survival prognosis. By contrast, a considerable proportion of MSCC patients live long enough to experience a local recurrence of MSCC in the previously irradiated area of the spinal cord. Long-course RT (30–40Gy in two to four weeks) results in significantly better local control than short-course RT and should therefore be administered to patients with a more favourable survival prognosis. Survival can be estimated with a newly developed scoring system. If re-irradiation is required, a second course of RT can be safely administered in most cases after primary short-course RT. After primary long-course RT, re-irradiation should optimally be performed with high-precision techniques in order to reduce the risk of radiation-related myelopathy.

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