Abstract
PurposeMetastatic 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.MethodsWe 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.DiscussionWe 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.ConclusionsOur 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.
Highlights
Metastatic epidural spinal cord compression (MESCC) is a devastating complication of advanced malignancy which can result in a significant deterioration in physicalDonovan et al Radiat Oncol (2020) 15:267 function and quality of life (QoL)
Our study aims to determine if stereotactic body radiation therapy (SBRT) is a feasible option in addition to standard 3D conformal palliative radiotherapy (3DCRT) for MESCC patients, with the goal to consider future randomized trials if successful
Eligible patients have a diagnosis of non-hematologic metastatic malignancy, with MESCC defined by presence of epidural tumor with evidence of contact with spinal cord on CT or Magnetic Resonance Imaging (MRI), and a motor score of 3 or greater on the Rades Motor Function Scale [6]
Summary
Metastatic epidural spinal cord compression (MESCC) is a devastating complication of advanced malignancy which can result in a significant deterioration in physicalDonovan et al Radiat Oncol (2020) 15:267 function and quality of life (QoL). Studies have indicated that regardless of 3DCRT fractionation regimen, overall response rates and post-treatment ambulatory rates are approximately 70%. This is in comparison to much higher post-surgical ambulatory rates at approximately 85% [1,2,3,4,5,6]. The durability of radiotherapy (RT) response, requirement of re-treatment, and effect on quality of life (QoL) remain pertinent issues requiring optimization [7]. With the development of new technologies, including high-dose ablative stereotactic body radiation therapy (SBRT) techniques, there may be opportunities to optimize response rates and durability of treatment for MESCC [8, 9]
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