One dose of radiotherapy relieves spinal cord compression in advanced cancer patients

Giving a single dose of radiotherapy to patients with cancer that has spread relieves spinal cord compression, a debilitating complication of advanced cancer.

The unpublished results of the SCORAD III trial, presented today at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, could help define the standard of care for patients with a short life expectancy who experience spinal cord compression.

Experts said the findings should lead to patients making fewer trips to hospital to control symptoms and reduce pain.

“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 Professor Peter Hoskin, from the Mount Vernon Cancer Centre in Middlesex. “For patients, this means fewer hospital visits and more time with family.”

Spinal cord compression occurs when a cancer spreads to bone near the spinal cord. As the tumour grows it can press on the spinal cord, causing symptoms such as pain, loss of movement or loss of bladder control.

Almost any type of cancer can spread to the spine. Around 3 to 5 in 100 people with cancer develop spinal cord compression.

Radiotherapy treatment is used to quickly shrink the tumour and relieve the pressure, but until now there has been no standard way of treating patients. The most common treatment patients receive is 5 doses of radiotherapy over 1 week.

The phase III trial, funded by Cancer Research UK, included 688 patients from hospitals in the UK and Australia. Patients had a range of cancers that had spread including prostate, breast, lung, and gastrointestinal tumours.

Half of the patients received a single 8 Gray (Gy) dose of radiotherapy while the other half received a total dose of 20 Gy split across 5 different days.

At the start of the study two thirds of patients (66%) were able to either walk normally or with a walking aid (such as a cane or walker).

8 weeks after treatment this increased to 70% of patients who received the single dose of radiotherapy and 73% of patients who received the larger dose over 5 days.

Overall survival of patients who had a single dose of radiotherapy was very similar to those receiving multiple smaller doses.

Professor John Yarnold, from The Institute of Cancer Research, London and a Cancer Research UK-funded expert in radiotherapy said: “This randomised study is the first reliable evidence that supports a single radiotherapy treatment instead of five daily treatments for compression of the spinal cord, a common complication in cancer that has spread.”

“The single large treatment dose has found to be as gentle on the healthy tissues and organs as the traditional five small treatments, and is just as effective in keeping patients mobile.”

Yarnold said this new approach would be a lot kinder to patients, who are often weakened by their cancer and treatment.

“A single visit for radiation treatment is a lot less tiring than a week of daily treatment, and means they can avoid being in hospital,” said Yarnold

Hoskin added that spotting and treating spinal cord compression quickly was vital in ensuring that radiotherapy is effective.

He said that in some cases longer periods of radiotherapy treatment may be beneficial for some patients, and further studies would help confirm this.

“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,” he said.