A trial looking at one dose of radiotherapy for cancer pressing on the spinal cord (SCORAD III)

Cancer type:

All cancer types
Secondary cancers

Status:

Results

Phase:

Phase 3

This trial compared 1 treatment of radiotherapy with 5 treatments of radiotherapy. It was to see if 1 treatment worked as well to treat people who have cancer pressing on the nerves in their spine.

Cancer in the spinal bones can cause pressure. Spinal cord compression happens when pressure on the spinal cord stops the nerves working normally.

Cancer Research UK supported this trial. 

This trial was open for people to join between 2010 and 2016. The team published results in 2019.

More about this trial

Doctors usually treat spinal cord compression with radiotherapy. When this trial was done, doctors weren’t sure how many radiotherapy treatments to give. 

Some people have one dose of radiotherapy. And some have a number of treatments over 5 to 10 days. The number of treatments depends on people’s general health and if they are having any other treatment. 

Doctors wanted to know whether the 2 different treatment plans gave similar results. They wanted to find out if a single dose (fraction) works just as well as 5 treatments. It would mean quicker treatment and less time in hospital.

In this trial, some people had 1 radiotherapy treatment. And some people had 5 treatments of radiotherapy over 5 days.

The trial compared the 2 treatment plans. The main aims were to find out:

  • if one radiotherapy treatment works as well as 5 treatments of radiotherapy 
  • more about the side effects and how people cope

    

Summary of results

Trial design
This was a phase 3 trial. 686 people took part. They were put into 1 of 2 groups at random:

  • 345 people had a single treatment (fraction) of radiotherapy. The total dose was 8 Gray Open a glossary item in 1 treatment. 
  • 341 people had 5 treatments of radiotherapy over 5 days. The total dose was 20 Gray of radiotherapy. 

Results
Spinal cord compression can be very painful and it can cause numbness in the limbs. This can cause difficulty walking. 

The team looked to see who could walk after radiotherapy treatment. This included people who needed a walking stick or another walking aid. 

This was done at 1, 4, 8 and 12 weeks after radiotherapy. 

At week 4 and week 12 there wasn’t much of a difference between the 2 treatment groups in terms of who could walk. 

The main time point the team measured was at 8 weeks. 342 people in the trial were living at this time. The team found:

  • 115 out of 166 people (69%) who had 1 treatment could walk 
  • 128 out 176 people (73%) who had 5 treatments could walk 

This difference between the groups was a little higher than the team were expecting. At 8 weeks, the team say these results show that 1 treatment wasn’t as good as 5. But they say it’s difficult to draw a firm conclusion at this time point. This was because of the way the trial was designed and the number of people who had died by week 8. This was because their cancer was very advanced and not because they took part in this trial. 

The team also looked at:

They didn’t find much of a difference in any of these between the 2 groups. 

Side effects
Nearly everyone taking part had at least 1 side effect, but some of these were mild. 

The team looked at the mild side effects. They found people who had 5 treatments had more problems with: 

  • skin reactions
  • tiredness 
  • their bladder, such as leaking urine or bladder inflammation 

The team also compared the groups to see who had more severe side effects. They didn’t find a significant difference between the 2 groups. 

Conclusion
The trial team assessed people at different time points looking at who could walk and at side effects. In the main, the team concluded that 1 treatment was as good as 5 treatments. But at 8 weeks, 1 treatment didn’t seem as good as 5 treatments in terms of who could walk. Although the team suggest that this finding needs careful interpretation.

More detailed information
There is more information about this research in the reference below. 

Please note, this article is not in plain English. It has been written for healthcare professionals and researchers.

Journal articles
Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer
P Hoskin and others
JAMA 2019. Volume 322, issue 21, pages 2084-2094.

Where this information comes from    
We have based this summary on the information in the article above. This has been reviewed by independent specialists peer reviewed Open a glossary item and published in a medical journal. We have not analysed the data ourselves. As far as we are aware, the links we list above are active and the article is free and available to view.
 

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Peter Hoskin 

Supported by

Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer
University College London (UCL)
 

Other information

This is Cancer Research UK trial number CRUK/06/034.

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

4271

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Over 60,000 cancer patients enrolled on clinical trials in the UK last year.

Last reviewed:

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