Single versus multifraction radiotherapy for spinal cord compression: A systematic review and meta-analysis

Donovan, Elysia; Sienna, Julianna; Mitera, Gunita; Tyagi, Nidhi Kumar; Parpia, Sameer; Swaminath, Anand

doi:10.1016/j.radonc.2019.01.019

Cited by 19 publications

(15 citation statements)

References 25 publications

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“…27 If radiation is indicated, over 30 studies have shown equivalent functional outcomes of single-fraction radiation treatment instead of multifraction radiation treatment, 4,28 with recent meta-analysis of 3 randomized clinical trials demonstrating preserved motor response with no clinical difference between single-fraction radiation treatment (8 Gy Â 1 fraction) and multifraction treatment at a 2-month timepoint. [29][30][31][32][33] However, there is conflicting evidence regarding the role of single-fraction RT for spinal cord compression, particularly given that the Single-fraction Radiotherapy Compared to Multifraction Radiotherapy III study did not meet its prespecified noninferiority endpoints, although the absolute difference of ambulatory status at 8 weeks was small (69.3% in the single-fraction group vs 72.7% in the multifraction group). 33 Nevertheless, 8 Gy Â 1 provides acceptable rates of palliation and allows for safe retreatment with either conventionally fractionated or stereotactic body radiation therapy approaches if warranted.…”

Section: Spinal Cord Compressionmentioning

confidence: 99%

Palliative Radiation Therapy for Oncologic Emergencies in the Setting of COVID-19: Approaches to Balancing Risks and Benefits

Yerramilli¹,

Xu²,

Gillespie

et al. 2020

Advances in Radiation Oncology

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Palliation of metastatic disease compromises a significant portion of radiation treatments in the United States. These patients present a unique challenge in resource-limited settings, as expeditious treatment is often required to prevent serious morbidity. In order to reduce the risk of infection with severe acute respiratory syndrome coronavirus-2 and maximize the benefit to patients, we present evidencebased recommendations for radiation in patients with oncologic emergencies. Radiation oncologists with expertise in the treatment of metastatic disease at a high-volume comprehensive cancer center reviewed the available evidence and recommended best practices for the treatment of common oncologic emergencies, with attention to balancing the risk of infection with severe acute respiratory syndrome coronavirus-2 and the potential morbidity of delaying treatment. Many prospective trials and national guidelines support the use of abbreviated courses of radiotherapy for patients with oncologic emergencies. As such, in the setting of the current coronavirus disease 2019 pandemic, the use of hypofractionated radiation therapy for patients requiring palliation for oncologic emergencies achieves desirable functional outcomes without compromising care.

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Section: Spinal Cord Compressionmentioning

confidence: 99%

Palliative Radiation Therapy for Oncologic Emergencies in the Setting of COVID-19: Approaches to Balancing Risks and Benefits

Yerramilli¹,

Xu²,

Gillespie

et al. 2020

Advances in Radiation Oncology

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“…A meta-analysis published in 2019 also concluded that there was no difference between short course and long course for motor response, bladder function, and OS with limited prognosis. 15 All the above randomized studies were done mainly in patients with solid tumors with limited survival using various fractionation schedules and different end points. All RT fractionation schedules demonstrated almost similar outcomes as far as pain and ambulation are concerned.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Palliative Radiotherapy in Metastatic Epidural Spinal Cord Compression in Lung Cancer—A Prospective Observational Study from Tata Memorial Hospital

Tibdewal

Sharma

Gurram

et al. 2021

South Asian J Cancer

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Background Metastatic epidural spinal cord compression (MESCC) secondary to lung cancer (LC) is a debilitating complication associated with poor prognosis and is commonly treated with radiotherapy (RT). There is no consensus for RT dose fractionation in spinal cord compression. Methods Forty consecutive patients of LC with radiological evidence of MESCC treated with palliative RT were evaluated for functional outcomes (pain, ambulation, and sphincter function) at 2-, 4-, and 24-week post RT completion. Pain assessment was done using visual analogue scale (VAS) and response was categorized according to international consensus criteria, ambulation status (AS) using Tomita’s scale, and sphincter function by the presence or absence of a catheter. Overall survival (OS) was assessed using Kaplan-Meier method and compared using log-rank test. Impact of potential prognostic factors on survival was also analyzed and p-value ≤0.05 was considered significant. Results Sixteen, 22, and two patients received 8 Gy single fraction (SF), 20 Gy in five fractions (20/5), and 30 Gy in 10 fractions (30/10), respectively. At 2 weeks, overall response (OR) rates of pain, ambulation, and sphincter control were 73, 81, and 81%, respectively. At 4 and 24 weeks, 93.7, 84.3, 87.5% and 88, 94, 76.5% had OR, respectively. Median OS was 4 months. Six- and 12-months OS was 50 and 37.5%. Nonsignificant difference in OS was seen between SF and 20/5 fractions (median 2.2 vs. 7.1 months, p = 0.39). Age ≤50 years was the only significant factor (p <0.05) in univariate analysis for OS. Conclusion Radiotherapy provided equivalent pain control, ambulation, and sphincter function compared with reported literature in MESCC. Nonsignificant difference in OS exists between SF and multifraction RT regimens.

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“…A recent systematic review of 3DCRT for MESCC indicated that despite no clear difference in motor outcomes or survival between single and short course regimens, patients still achieve inferior outcomes compared with surgical patients in motor response and ambulation, durability of response, and survival with 3DCRT [ 4 ]. Approximately 30% of patients required re-treatment of the spinal cord after 3DCRT, and a low proportion of patients were able to regain ambulatory capacity if initially non-ambulatory, indicating that there may be patients who will benefit from dose-escalated RT [ 4 ]. Inferior outcomes have also been demonstrating in MESCC receiving longer courses of radiotherapy [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…A majority of patients are therefore generally treated with less aggressive therapies, most commonly 3D conformal palliative radiotherapy (3DCRT) alone, delivered in one to ten fractions [ 1 – 4 ]. Studies have indicated that regardless of 3DCRT fractionation regimen, overall response rates and post-treatment ambulatory rates are approximately 70%.…”

Section: Introductionmentioning

confidence: 99%

A pilot study of stereotactic boost for malignant epidural spinal cord compression: clinical significance and initial dosimetric evaluation

et al. 2020

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Purpose Metastatic epidural spinal cord compression (MESCC) is a devastating complication of advanced malignancy, which can result in neurologic complications and significant deterioration in overall function and quality of life. Most patients are not candidates for optimal surgical decompression and as a result, receive urgent 3D conformal radiotherapy (3DCRT) to prevent or attempt to reverse neurologic progression. Multiple trials indicate that response and ambulatory rates after 3DCRT are inferior to surgery. The advent of stereotactic body radiation therapy (SBRT) has created a method with which a “radiosurgical decompression” boost may facilitate improve outcomes for MESCC patients. Methods We are conducting a pilot study to investigate SBRT boost after urgent 3D CRT for patients with MESCC. The aim of the study is to establish feasibility of this two-phase treatment regimen, and secondarily to characterize post-treatment ambulation status, motor response, pain control, quality of life and survival. Discussion We describe the study protocol and present a case report of one patient. A quality assurance review was conducted after the first seven patients, and resultant dose-constraints were revised to improve safety and feasibility of planning through more conservative organ at risk constraints. There have been no severe adverse events (grade 3–5) to date. We have illustrated clinical and dosimetric data of an example case, where a patient regained full strength and ambulatory capacity. Conclusions Our study aims to determine if SBRT is a feasible option in addition to standard 3DCRT for MESCC patients, with the goal to consider future randomized trials if successful. Having a robust quality assurance process in this study ensures translatability going forward if future trials with multicenter and increased patient representation are to be considered. Trial registration clinicaltrials.gov; registration no. NCT03529708; https://clinicaltrials.gov/ct2/show/NCT03529708; First posted May 18, 2018.

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Single versus multifraction radiotherapy for spinal cord compression: A systematic review and meta-analysis

Cited by 19 publications

References 25 publications

Palliative Radiation Therapy for Oncologic Emergencies in the Setting of COVID-19: Approaches to Balancing Risks and Benefits

Palliative Radiation Therapy for Oncologic Emergencies in the Setting of COVID-19: Approaches to Balancing Risks and Benefits

Outcomes of Palliative Radiotherapy in Metastatic Epidural Spinal Cord Compression in Lung Cancer—A Prospective Observational Study from Tata Memorial Hospital

A pilot study of stereotactic boost for malignant epidural spinal cord compression: clinical significance and initial dosimetric evaluation

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