Single-versus multi-fraction radiation treatment for metastatic spinal cord compression: functional outcome study

Abu-Hegazy, Mohammad; Wahba, Hanan Ahmed

doi:10.1007/s10330-011-0832-5

Cited by 11 publications

(14 citation statements)

References 21 publications

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“…One single-center 3-group randomized trial from Egypt with 285 patients compared single-fraction radiotherapy with 10 or 20 fractions of radiotherapy, but was not designed for noninferiority. 8 The other study was designed for noninferiority and compared single-fraction radiotherapy with 5 fractions of radiotherapy, but failed to reach its target accrual. 14,15,21 Two trials have shown noninferiority of short-course radiotherapy; 1 trial compared 8 Gy of radiotherapy in 1 fraction with nonstandard 16 Gy of radiotherapy in 2 fractions 16 and the other compared 16 Gy in 2 fractions vs 30 Gy in 8 fractions with a split-course schedule.…”

Section: Discussionmentioning

confidence: 99%

“…However, the evidence for using single-fraction radiotherapy comes from trials based on patients with bone pain from metastatic disease (eg, pelvis, long bones, skull) after excluding metastatic spinal canal compression at diagnosis. 5,6 A systematic review 7 on spinal canal compression consisting of only retrospective studies (which tend to be affected by bias and confounding), aside from 1 randomized clinical trial, 8 reported similar outcomes between singlefraction and multifraction radiotherapy.…”

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confidence: 99%

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Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer

Hoskin

Hopkins

Misra

et al. 2019

JAMA

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IMPORTANCE Malignant spinal canal compression, a major complication of metastatic cancer, is managed with radiotherapy to maintain mobility and relieve pain, although there is no standard radiotherapy regimen. OBJECTIVE To evaluate whether single-fraction radiotherapy is noninferior to 5 fractions of radiotherapy. DESIGN, SETTING, AND PARTICIPANTS Multicenter noninferiority randomized clinical trial conducted in 42 UK and 5 Australian radiotherapy centers. Eligible patients (n = 686) had metastatic cancer with spinal cord or cauda equina compression, life expectancy greater than 8 weeks, and no previous radiotherapy to the same area. Patients were recruited between February 2008 and April 2016, with final follow-up in September 2017. INTERVENTIONS Patients were randomized to receive external beam single-fraction 8-Gy radiotherapy (n = 345) or 20 Gy of radiotherapy in 5 fractions over 5 consecutive days (n = 341). MAIN OUTCOMES AND MEASURES The primary end point was ambulatory status at week 8, based on a 4-point scale and classified as grade 1 (ambulatory without the use of aids and grade 5 of 5 muscle power) or grade 2 (ambulatory using aids or grade 4 of 5 muscle power). The noninferiority margin for the difference in ambulatory status was −11%. Secondary end points included ambulatory status at weeks 1, 4, and 12 and overall survival. RESULTS Among 686 randomized patients (median [interquartile range] age, 70 [64-77] years; 503 (73%) men; 44% had prostate cancer, 19% had lung cancer, and 12% had breast cancer), 342 (49.8%) were analyzed for the primary end point (255 patients died before the 8-week assessment). Ambulatory status grade 1 or 2 at week 8 was achieved by 115 of 166 (69.3%) patients in the single-fraction group vs 128 of 176 (72.7%) in the multifraction group (difference, −3.5% [1-sided 95% CI, −11.5% to ϱ]; P value for noninferiority = .06). The difference in ambulatory status grade 1 or 2 in the single-fraction vs multifraction group was −0.4% (63.9% vs 64.3%; [1-sided 95% CI, −6.9 to ϱ]; P value for noninferiority = .004) at week 1, −0.7% (66.8% vs 67.6%; [1-sided 95% CI, −8.1 to ϱ]; P value for noninferiority = .01) at week 4, and 4.1% (71.8% vs 67.7%; [1-sided 95% CI, −4.6 to ϱ]; P value for noninferiority = .002) at week 12. Overall survival rates at 12 weeks were 50% in the single-fraction group vs 55% in the multifraction group (stratified hazard ratio, 1.02 [95% CI, 0.74-1.41]). Of the 11 other secondary end points that were analyzed, the between-group differences were not statistically significant or did not meet noninferiority criterion. CONCLUSIONS AND RELEVANCE Among patients with malignant metastatic solid tumors and spinal canal compression, a single radiotherapy dose, compared with a multifraction dose delivered over 5 days, did not meet the criterion for noninferiority for the primary outcome (ambulatory at 8 weeks). However, the extent to which the lower bound of the CI overlapped with the noninferiority margin should be considered when interpreting the clinical importance of this...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer

Hoskin

Hopkins

Misra

et al. 2019

JAMA

View full text Add to dashboard Cite

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“…After a comprehensive search, 33 full-text articles were assessed for eligibility, and 19 of them were excluded (interventions of 12 studies do not meet the inclusion criteria, 3 were review, 3 were single-arm trials, and from 1 data cannot be extracted); therefore, only 14 eligible studies 5 , 6 , 9 – 11 , 15 – 23 were included. The selection process was shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The selection process was shown in Figure 1 . Only 1 study was RCT, which was published in Egypt, 23 1 was nonrandomized prospective study, 20 and the rest were all retrospective studies, which were written by the same first author in Germany. Though there are some overlapping data, it was reported in different outcomes.…”

Section: Resultsmentioning

confidence: 99%

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Comparison of Short-Course Radiotherapy Versus Long-Course Radiotherapy for Treatment of Metastatic Spinal Cord Compression

Meng

Liang

et al. 2015

Medicine

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In this study, we evaluate the efficacy of short-course radiotherapy (SCRT) versus long-course radiotherapy (LCRT) in the treatment of metastatic spinal cord compression (MSCC).PubMed, EMBASE, and Web of Science were searched up to April 2015. Relevant data were extracted based on inclusion and exclusion criteria. Methodological quality of randomized controlled trial (RCT) was evaluated using modified Jadad scale; non-RCT was evaluated using Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3 software.Fourteen studies with 2239 patients were included. Results of meta-analysis showed that there were no significant differences between SCRT and long-course radiotherapy LCRT in 6-month overall survival rate (risk ratio [RR] = 0.97, 95% confidence interval [CI] 0.88, 1.07, P = 0.55), 1-year overall survival rate (RR = 0.94, 95% CI 0.85, 1.04, P = 0.22), motor function improvement (RR = 0.96, 95% CI 0.81, 1.13, P = 0.63), no change on motor function (RR = 0.98, 95% CI (0.88, 1.09), P = 0.74], and deterioration on motor function (RR = 0.96, 95% CI 0.71, 1.31, P = 0.78). Compared with SCRT, LCRT significantly increased 6-month local control rate (RR = 0.87, 95% CI 0.80, 0.95, P = 0.002), 1-year local control rate (RR = 0.83, 95% CI 0.71, 0.97, P = 0.02), and 2-year local control rate (RR = 0.83, 95% CI 0.79, 0.87, P < 0.00001).Both LCRT and SCRT provided similar survival rates and functional outcome, but LCRT showed better local control rates than SCRT. However, considering low cost and good patient's compliance, SCRT may be a better choice.

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Interventions for the treatment of metastatic extradural spinal cord compression in adults

George

Sundararaj

Govindaraj

et al. 2015

Cochrane Database of Systematic Reviews

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Based on current evidence, ambulant adults with MESCC with stable spines and predicted survival of less than six months will probably benefit as much from one dose of radiation (8 Gy) as from two doses (16 Gy) or eight doses (30 Gy). We are unsure if a single dose is as effective as two or more doses in preventing local tumour recurrence. Laminectomy preceding radiotherapy may offer no benefits over radiotherapy alone. Decompressive surgery followed by radiotherapy may benefit ambulant and non-ambulant adults younger than 65 years of age, with poor prognostic factors for radiotherapy, a single area of compression, paraplegia for less than 48 hours, and a predicted survival of more than six months. We are uncertain whether high doses of corticosteroids offer any benefits over moderate doses or indeed no corticosteroids; but high-dose steroids probably significantly increases the risk of serious adverse effects. Early detection; and treatment based on neurological status, age and estimated survival, are crucial with all treatment modalities. Most of the evidence was of low quality. High-quality evidence from more trials is needed to clarify current uncertainties, and some studies are in progress.

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Single-versus multi-fraction radiation treatment for metastatic spinal cord compression: functional outcome study

Cited by 11 publications

References 21 publications

Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer

Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer

Comparison of Short-Course Radiotherapy Versus Long-Course Radiotherapy for Treatment of Metastatic Spinal Cord Compression

Interventions for the treatment of metastatic extradural spinal cord compression in adults

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