Radiotherapy for metastatic spinal cord compression with increased radiation doses (RAMSES-01): a prospective multicenter study

Abstract

BackgroundPatients with metastatic spinal cord compression (MSCC) and favorable survival prognoses can benefit from radiation doses greater than 30Gy in 10 fractions in terms of improved local progression-free survival (LPFS) and overall survival (OS).Methods/designThis prospective study mainly investigates LPFS after precision radiotherapy (volumetric modulated arc therapy or stereotactic body radiotherapy) with 18 × 2.33Gy in 3.5 weeks. LPFS is defined as freedom from progression of motor deficits during radiotherapy and an in-field recurrence of MSCC following radiotherapy. The maximum relative dose allowed to the spinal cord is 101.5% of the prescribed dose, resulting in an equivalent dose in 2Gy-fractions (EQD2) for radiation myelopathy is 45.5Gy, which is below the tolerance dose of 50Gy according to the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC). The EQD2 of this regimen for tumor cell kill is 43.1Gy, which is 33% higher than for 30Gy in 10 fractions (EQD2 = 32.5Gy). Primary endpoint is LPFS at 12 months after radiotherapy. Secondary endpoints include the effect of 18 × 2.33Gy on motor function, ambulatory status, sensory function, sphincter dysfunction, LPFS at other follow-up times, overall survival, pain relief, relief of distress and toxicity. Follow-up visits for all endpoints will be performed directly and at 1, 3, 6, 9 and 12 months after radiotherapy. A total of 65 patients are required for the prospective part of the study. These patients will be compared to a historical control group of at least 235 patients receiving conventional radiotherapy with 10x3Gy in 2 weeks.DiscussionIf precision radiotherapy with 18 × 2.33Gy results in significantly better LPFS than 10x3Gy of conventional radiotherapy, this regimen should be strongly considered for patients with MSCC and favorable survival prognoses.Trial registrationClinicaltrials.gov NCT04043156. Registered 30-07-2019.

Natural disease progression and novel survival prediction model for hepatocellular carcinoma with spinal metastases: a 10-year single-center study

“…This could be explained by the lower rate of primary surgical resection and higher rate of palliative treatment and best supportive care in our study. As the median survival time after the diagnosis of spinal metastases was much shorter than characteristics [22][23][24][25]. For tumor-related or intervention-related factors, primary HCC control or response to HCC treatment (i.e., response to radiotherapy, previous resection of primary HCC) were reported to be associated with patient survival after the diagnosis of spinal metastases [6,20,22,24].…”

Patterns of Palliative Radiotherapy Utilization for Patients With Metastatic Breast Cancer in Harare, Zimbabwe

“…3 Multifractionated regimens are the standard for patients with brain and complicated spine metastases as opposed to most patients with bone metastasis who benefit from single-fraction treatments. 40,[43][44][45][46] Despite longer fractionations, most patients completed the planned RT course. This is encouraging as shorter fractionations increase capacity for additional patients to be treated and reduce RT time, potentially reducing the chances of treatment noncompletion because of machine breakdowns.…”

Natural disease progression and novel survival prediction model for hepatocellular carcinoma with spinal metastases: a 10-year single-center study

“…Interestingly, most of these factors were either patient-related (i.e., Eastern Cooperative Oncology The Revised Tokuhashi score predicts for the patient to be alive at 6 months if the score is 9-15 points. Patients with a Tomita score of < 9 points are predicted not to be alive at 6 months Group or ECOG and KPS) [6,[20][21][22], liver-related (i.e., serum albumin level, serum lactate dehydrogenase or LDH, and Child-Pugh classification) [6,21,23,24], or metastatic-related (visceral metastasis, other extrahepatic metastasis other than bone metastases) characteristics [22][23][24][25]. For tumor-related or intervention-related factors, primary HCC control or response to HCC treatment (i.e., response to radiotherapy, previous resection of primary HCC) were reported to be associated with patient survival after the diagnosis of spinal metastases [6,20,22,24].…”