Dirk Rades1, Barbara Šegedin2, Antonio J Conde-Moreno2, Raquel Garcia2, Ana Perpar2, Michaela Metz2, Harun Badakhshi2, Andreas Schreiber2, Mirko Nitsche2, Peter Hipp2, Wolfgang Schulze2, Irenaeus A Adamietz2, Darius Norkus2, Volker Rudat2, Jon Cacicedo2, Steven E Schild2. 1. Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ. rades.dirk@gmx.net. 2. Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
Abstract
PURPOSE: To compare short-course radiotherapy (RT) (4 Gy × 5) to longer-course RT (3 Gy × 10) for metastatic epidural spinal cord compression (MESCC). PATIENTS AND METHODS: Two-hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy × 5 in 1 week (n = 101) or 3 Gy × 10 in 2 weeks (n = 102). Patients were stratified according to ambulatory status, time developing motor deficits, and primary tumor type. Seventy-eight and 77 patients, respectively, were evaluable for the primary end point, 1-month overall response regarding motor function defined as improvement or no further progression of motor deficits. Other study end points included ambulatory status, local progression-free survival, and overall survival. End points were evaluated immediately after RT and at 1, 3, and 6 months thereafter. RESULTS: At 1 month, overall response rates regarding motor function were 87.2% after 4 Gy × 5 and 89.6% after 3 Gy × 10 (P = .73). Improvement rates were 38.5% and 44.2%, respectively, no further progression rates 48.7% and 45.5%, respectively, and deterioration rates 12.8% and 10.4%, respectively (P = .44). Ambulatory rates at 1 month were 71.8% and 74.0%, respectively (P = .86). At other times after RT, the results were also not significantly different. Six-month local progression-free survival was 75.2% after 4 Gy × 5 and 81.8% after 3 Gy × 10 (P = .51); 6-month overall survival was 42.3% and 37.8% (P = .68). CONCLUSION: Short-course RT with 4 Gy × 5 was not significantly inferior to 3 Gy × 10 in patients with MESCC and poor to intermediate expected survival.
RCT Entities:
PURPOSE: To compare short-course radiotherapy (RT) (4 Gy × 5) to longer-course RT (3 Gy × 10) for metastatic epidural spinal cord compression (MESCC). PATIENTS AND METHODS: Two-hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy × 5 in 1 week (n = 101) or 3 Gy × 10 in 2 weeks (n = 102). Patients were stratified according to ambulatory status, time developing motor deficits, and primary tumor type. Seventy-eight and 77 patients, respectively, were evaluable for the primary end point, 1-month overall response regarding motor function defined as improvement or no further progression of motor deficits. Other study end points included ambulatory status, local progression-free survival, and overall survival. End points were evaluated immediately after RT and at 1, 3, and 6 months thereafter. RESULTS: At 1 month, overall response rates regarding motor function were 87.2% after 4 Gy × 5 and 89.6% after 3 Gy × 10 (P = .73). Improvement rates were 38.5% and 44.2%, respectively, no further progression rates 48.7% and 45.5%, respectively, and deterioration rates 12.8% and 10.4%, respectively (P = .44). Ambulatory rates at 1 month were 71.8% and 74.0%, respectively (P = .86). At other times after RT, the results were also not significantly different. Six-month local progression-free survival was 75.2% after 4 Gy × 5 and 81.8% after 3 Gy × 10 (P = .51); 6-month overall survival was 42.3% and 37.8% (P = .68). CONCLUSION: Short-course RT with 4 Gy × 5 was not significantly inferior to 3 Gy × 10 in patients with MESCC and poor to intermediate expected survival.
Authors: Zain A Husain; Arjun Sahgal; Eric L Chang; Pejman Jabehdar Maralani; Charlotte D Kubicky; Kristin J Redmond; Charles Fisher; Ilya Laufer; Simon S Lo Journal: CNS Oncol Date: 2017-07-18
Authors: Julio C Furlan; Jefferson R Wilson; Eric M Massicotte; Arjun Sahgal; Michael G Fehlings Journal: Neuro Oncol Date: 2022-01-05 Impact factor: 13.029
Authors: Dirk Rades; Jon Cacicedo; Antonio J Conde-Moreno; Claudia Doemer; Jürgen Dunst; Darejan Lomidze; Barbara Segedin; Denise Olbrich; Niels Henrik Holländer Journal: BMC Cancer Date: 2017-12-04 Impact factor: 4.430