Abstract
BackgroundIn a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radiotherapy should be as short as possible. This study compared 5 × 5 Gy in 1 week to 10 × 3 Gy in 2 weeks in a prospective cohort.MethodsForty patients receiving 5 × 5 Gy in a phase II trial were matched 1:2 to 213 patients receiving 10 × 3 Gy in two previous prospective studies for tumor type, ambulatory status, time developing motor deficits, interval between tumor diagnosis and MSCC and visceral metastases. These factors were consistent in all three patients (triple) used for each 1:2 matching. Groups were compared for local progression-free survival (LPFS), motor function, ambulatory status, and overall survival (OS).ResultsAfter matching, 32 triples remained for analyses (N = 96 in total). Six-month LPFS-rates were 94% after 5 × 5 Gy and 87% after 10 × 3 Gy (p = 0.36), 6-month OS-rates 43% and 35% (p = 0.74). Improvement of motor function was achieved in 59% and 34% of patients (p = 0.028); overall response rates (improvement or no further progression of motor deficits) were 94% and 89% (p = 0.71). Post-treatment ambulatory rates were 81% after 5 × 5 Gy and 85% after 10 × 3 Gy (p = 0.61). Of non-ambulatory patients, 50% (6/12) and 46% (11/24) regained the ability to walk (p = 1.00).Conclusions5 × 5 Gy in 1 week appeared similarly effective as 10 × 3 Gy in 2 weeks. These results may not be applicable to long-term survivors and should be confirmed in a randomized trial directly comparing 5 × 5 Gy and 10 × 3 Gy.Trial registration clinicaltrials.gov NCT03070431. Registered 27 February 2017.
Highlights
In a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radio‐ therapy should be as short as possible
Improvement of motor function was achieved in 59% (19/32) and 34% (22/64) of patients (p = 0.028)
Deterioration of motor deficits occurred in 6% (2/32) and 11% (7/64) of patients (p = 0.71)
Summary
In a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radio‐ therapy should be as short as possible. This study compared 5 × 5 Gy in 1 week to 10 × 3 Gy in 2 weeks in a prospec‐ tive cohort. Since treatment sessions can be inconvenient for these patients, the ideal radiation program should be effective and short. These criteria may be met by 5 × 5 Gy in 1 week with an EQD2 similar to 10 × 3 Gy. In a previous phase II trial, 5 × 5 Gy resulted in significantly better LPFS than 5 × 4 Gy [8]. A comparison between 5 × 5 Gy and 10 × 3 Gy was lacking, so we performed this analysis using data of three prospective studies [8,9,10]
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