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

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  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:

• other treatments people had 
• quality of life
• pain

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  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.