Woman with cancer after radiation therapy in hospital

A common complication in people with metastatic cancer, spinal cord compression or SCC, is a major detriment to Quality of Life (QoL). The symptoms of spinal cord compression can vary. They may be mild at first or pain may be the only symptom. As the tumor puts more pressure on the spine, the symptoms become worse and more serious.[1]

Radiation treatment is widely used to relieve pain and other symptoms, but there is no standard recommended schedule. Approaches currently vary and Radiation Treatment ranges from single dose 8Gy to 40Gy in 20 fractions.

Findings from the phase III SCORAD clinical trial, funded by Cancer Research UK, show that a single radiation treatment is as effective as a full week of radiation.[2]

The study was presented at the 53rd annual meeting of the American Society of Clinical Oncology (ASCO), held in Chicago, Ill.

Port Worthy

Single-dose radiotherapy
?Our findings establish single-dose radiotherapy as the standard of care for metastatic spinal canal compression, at least for patients with a short life expectancy,? said lead study author Peter Hoskin, MD, FCRP, FRCR, an oncologist at the Mount Vernon Cancer Centre in Middlesex, United Kingdom.

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?For patients, this means fewer hospital visits and more time with family,? Hoskin added.

Incidence and Risk
While every year a large number of people are diagnosed with cancer, there is a relatively low risk of spinal cord compression. And, on average, 23% of patients with SCC have no prior cancer diagnosis. [3]

When cancer spreads to the bones, it most commonly affects the spine. Tumors in the spine can put pressure on the spinal canal, causing back pain, numbness, tingling, and difficulty walking. Many patients with advanced solid tumors develop bone metastases, and up to 10% of all patients with cancer will have metastatic spinal cord compression.

Study design
The study enrolled and randomized (1:1) a total of 688 patients from 44 centers in the United Kingdom and 4 in Australia.? The patients were diagnosed with metastatic prostate (44%), lung (18%), breast (11%), and gastrointestinal cancers (11%). The median age was 70 years, and 73% were male. The researchers randomly assigned patients (n=345 single dose, n=343 multifraction) to receive external beam spinal canal radiation therapy either as a single dose of 8 Gy or as 20 Gy split in five doses over five days, stratified by RT center, ambulatory status (AS), site of primary, and presence or absence of non-skeletal metastases.

The primary endpoint of the study was ambulatory status, measured on a four-point scale:

Grade 1: Able to walk normally
Grade 2: Able to walk with walking aid (such as cane or walker)
Grade 3: Has difficulty walking even with walking aids
Grade 4: Dependent on wheelchair

At study entry, 66% of patients had ambulatory status 1 to 2.

Key Findings
At eight weeks, 69.5% of patients who received single-dose radiation therapy and 73.3% of those who received five doses had ambulatory status 1 to 2, showing that both shorter- and longer-course radiation treatments helped patients stay mobile.

The median overall survival was similar in the two groups ? 12.4 weeks with single dose vs. 13.7 weeks with five doses (the difference was not statistically significant). The proportion of patients with severe side effects was similar in the two groups (20.6% vs. 20.4%), but mild side effects were less common in the single-dose group (51% vs. 56.9%).

Prof. Hoskin emphasized that early recognition and prompt treatment of spinal cord compression symptoms are critical to achieve best results with radiation therapy.

“Spinal cord compression is a debilitating condition that many patients with advanced cancer experience. Until now, patients often had to spend multiple days traveling back and forth to undergo radiation treatments,” noted Joshua A. Jones, MD, MA, Assistant Professor of Radiation Oncology at the Hospital of the University of Pennsylvania and independent ASCO Expert not associated with the study.

“This study means that without compromising care, we can help patients have more time to focus on the things they enjoy instead of on the cancer,” Jones added.

Limitations and Next Steps
?Longer radiation may be more effective for preventing regrowth of metastases in the spine than single-dose radiation. Therefore, a longer course of radiation may still be better for patients with a longer life expectancy, but we need more research to confirm this,? Hoskin said.

Patients with metastatic breast cancer were under-represented in this clinical trial, as were younger patients. For certain patients with spinal cord compression, surgery instead of or in addition to radiation therapy may be recommended.

Last editorial review: June 6, 2017

Featured Image: Woman with cancer after radiation therapy in hospital Courtesy: ? 2017 Fotolia Used with permission.

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