Important Studies

Question 1

Benefit of surgery?

Answer 1

University of Kentucky Medical Center. Patchell et al, Lancet, 2005. Spinal cord compression at one site caused by metastatic solid tumor. Cannot have been paraplegic for >48 hours. Expected survival of 3 months. “→Surgery with 30 Gy RT vs. 30 Gy RT alone Endpoint: ability to walk 4 steps. Most surgery was anterior approach”. Laminectomy plus RT improves ability to walk over RT alone.

Question 2

Nomogram?

Answer 2

University Hospital Schleswig-Holstein, Luebeck, Germany. Rades et al, IJROBP, 2008. Metastatic spinal cord compression. This nomogram helps guide treatment opions including best supportive care, surgery, and radiation

Question 3

Single fraction vs. Short course RT?

Answer 3

SCORAD III. Hoskin et al, JAMA, 2019. Metastatic epidural cord compression. “→Single fraction 8 Gy x 1 vs. Short course 4 Gy x 5. Primary endpoint ambulatory status (AS) at week 8. Secondary endpoints: weeks 1, 4, and 12. Single fraction vs. short course RT for cord compression was not found to be noninferior at the primary endpoint of 8 weeks. However secondary endpoints at week 1, 4, and 12 were noninferior. Altogether the results are similar and suggest effectiveness of the single fraction regimen.

Question 4

Short vs Long course RT?

Answer 4

SCORE-2 (AR0 2009/01). “Rades et al, JCO, 2016
Rades et al, IJROBP, 2019”. Metastatic epidural cord compression. “→Short course 4 Gy x 5 vs. Long course 3 Gy x 10”. Short course 5 fx RT to 20 Gy is noninferior to long course 10 fx to 30 Gy in metastatic cord compression in pain relief, distress, ambulatory rates, improvement, no further progression, or deterioration.

University of Germany, Lubeck. Rades et al, IJROBP, 2011. Metastatic spinal cord compression. “→Short course 8 Gy x 1 or 4 Gy x 5 vs. Long course 3 Gy x 10 or 2.5 Gy x 20”. Long course regimens lead to improved LC for cord compression compared to short course. Good prognosis patients should be considered for long course RT.

Question 5

SBRT spine?

Answer 5

University of Pittsburgh. Gerszten et al, Spine, 2007. Spine metastasis. (73 cervical, 212 T, 112 L, 103 S). SRS to spinal metastases results in favorable outcomes.

RTOG 0631. Ryu et al, ASTRO, 2019. 1-3 spine metastasis, localized, NRPS score of ≥5. “→SBRT 16 or 18 Gy single fx (as low as 80% coverage permitted) vs. EBRT 8 Gy single fx”. Single fraction SBRT and EBRT to spine show no difference in pain response or adverse effects.