Image: A new study shows a single dose of radiation therapy can treat metastatic spinal cord compression (Photo courtesy of NCI).
A new study suggests that a single radiation therapy (RT) treatment is as effective as a full week of RT for treating spinal cord compression (SCC), a common complication of metastatic cancer.
The phase III clinical trial, conducted at Mount Vernon Cancer Centre (Northwood, United Kingdom), enrolled 688 patients (median 70 years, 73% male) with metastatic prostate (44%), lung (18%), breast (11%), and gastrointestinal cancers (11%). The researchers randomly assigned the patients to receive external beam spinal canal radiation therapy either as a single dose of 8 Gy or as a 20 Gy dose split in five doses over five days. The primary endpoint of the study was ambulatory status, measured on a four-point scale.
The results showed that at eight weeks, 69.5% of patients who received single-dose RT and 73.3% of those who received five doses had ambulatory status 1 (normal walking) or 2 (able to walk with walking aid), showing that both shorter- and longer-course RT treatments helped patients stay mobile. The median overall survival was similar in both groups, as were side effects, but mild side effects were less common in the single-dose group. The study was presented at the American Society of Clinical Oncology (ASCO) annual meeting, held during June 2017 in Chicago (IL, 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. For patients, this means fewer hospital visits and more time with family,” said lead author and study presenter oncologist Peter Hoskin, MD. “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.”
Metastatic SCC is a spinal cord or cauda equina compression by direct pressure and/or induction of vertebral collapse or instability, which leads to irreversible neurological damage such as paraplegia or tetraplegia, depending on the level of the lesion. Up to 10% of all cancer patients will have metastatic SCC, and early diagnosis and treatment are essential to prevent permanent neurological damage.
Mount Vernon Cancer Centre