SCORAD III: Randomized noninferiority phase III trial of single-dose radiotherapy (RT) compared to multifraction RT in patients (pts) with metastatic spinal canal compression (SCC).

Hoskin, Peter; Misra, Vivek; Hopkins, Kirsten; Holt, Tanya; Brown, Guy J.; Arnott, Seonaid; Thomas, Sharon Shibu; Reczko, Krystyna; Beare, Sandy; Lopes, Andre; Forsyth, Sharon

doi:10.1200/jco.2017.35.15_suppl.lba10004

Cited by 12 publications

(4 citation statements)

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“…Our attitude was to establish a better way to treat all patients who can benefit from radiotherapy; not to delay the onset of any patient whose deferral may worsen the prognosis of their disease; try to help the patient attend treatment as few times as possible and not increasing toxicity and maintaining the possibility of the best result. The hypofractionated treatments we indicated during the time of COVID-19 are supported mainly by international guidelines and phase III clinical trials [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Methodsmentioning

confidence: 99%

COVID-19: hypofractionation in the Radiation Oncology Department during the “State of Alarm”: first 100 patients in a private hospital in Spain

Larrea¹,

López²,

Antonini³

et al. 2020

ecancer

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During the COVID-19 pandemic, Spain declared a 'state of alarm' on 14 March 2020. In our Radiation Oncology Department, experienced in administering hypofractionated treatments (partial irradiation in breast cancer, moderate hypofractionation in localized prostate cancer, etc), we have increased the hypofractionated treatment indications. We are only deferring the start of non-urgent treatments such as prostate tumours under androgen deprivation or benign brain tumours which are candidates for radiosurgery such as meningiomas or acoustic neuroma. In this hypofractionation era we find that we have decreased the number of sessions per patient and that we can evaluate the last years with the fractionation index (FI) (calculated by dividing the total number of fractions administered in the department by the total number of patients treated). We have gone from 14.4 in 2018 to 13.78 in 2019, excluding brachytherapy. We report the results of the first 100 patients who have experienced radiotherapy treatment since the state of alarm (66 women and 34 men). In these patients, the FI is 12.12lower than previous years.

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Section: Methodsmentioning

confidence: 99%

COVID-19: hypofractionation in the Radiation Oncology Department during the “State of Alarm”: first 100 patients in a private hospital in Spain

Larrea¹,

López²,

Antonini³

et al. 2020

ecancer

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“…The most common short-course program used for MSCC is 20 Gy in 5 daily fractions administered on consecutive working days [2]. Generally, short-course programs are used for patients with a survival prognosis of a few months [3, 4, 7], whereas patients with a favorable prognosis, e.g. of more than 6 months, may benefit from longer-course programs with higher total doses in terms of improved local control of MSCC [12].…”

Section: Discussionmentioning

confidence: 99%

“…In all three groups, those patients who appeared appropriately treated with 20 Gy in 5 fractions and have a poor survival prognosis of only a few months may be considered for single-fraction RT with 8 Gy or 10 Gy instead of 20 Gy in 5 fractions, because in previous studies including randomized trials single-fraction RT was not inferior to multi-fraction short-course RT for MSCC in patients with a poor estimated survival [3, 4, 8].…”

Section: Discussionmentioning

confidence: 99%

“…For MSCC, different dose-fractionation schedules are used, and of these, 30 Gy in 10 fractions over 2 weeks and 20 Gy in 5 fractions over 1 week are most commonly employed. Short-course RT with 20 Gy in 5 fractions or 8–10 Gy in 1 fraction has become quite popular to keep the treatment time as short as possible for this palliative situation, [3, 4]. This trend was supported by previous studies reporting this regimen was non-inferior to longer ones lasting 2 to 4 weeks with respect to motor function and post-trreatment ambulation rates [5–7].…”

Section: Introductionmentioning

confidence: 95%

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A scoring system to predict local progression-free survival in patients irradiated with 20 Gy in 5 fractions for malignant spinal cord compression

et al. 2018

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BackgroundLocal progression-free survival (LPFS = stable or improved motor function/resolution of paraplegia during RT without in-field recurrence following RT) is important when treating metastatic spinal cord compression (MSCC). An instrument to estimate LPFS was created to identify patients appropriately treated with short-course RT instead of longer-course RT plus/minus decompressive surgery.MethodsIn 686 patients treated with 20 Gy in 5 fractions alone, ten characteristics were retrospectively analyzed for LPFS including age, interval between tumor diagnosis and RT of MSCC, visceral metastases, other bone metastases, primary tumor type, gender, time developing motor deficits, pre-RT gait function, number of vertebrae affected by MSCC, and performance score. Characteristics significantly (p < 0.05) associated with LPFS on multivariate analyses were incorporated in the scoring system. Six-month LPFS rates for significant characteristics were divided by 10, and corresponding points were added.ResultsOn multivariate analyses, visceral metastases (p < 0.001), tumor type (p = 0.009), time developing motor deficits (p < 0.001) and performance score (p = 0.009) were associated with LPFS and used for the scoring system. Scores for patients ranged between 24 and 35 points. Three groups were designed: 24–28 (A), 29–31 (B) and 32–35 (C) points. Six-month LPFS rates were 46, 69 and 92%, 12-month LPFS rates 46, 63 and 83%. Median survival times were 2 months (61% died within 2 months), 4 months and ≥ 11 months (median not reached).ConclusionsMost group A patients appeared sub-optimally treated with 20 Gy in 5 fractions. Patients with survival prognoses ≤2 months may be considered for best supportive care or single-fraction RT, those with prognoses ≥3 months for longer-course RT plus/minus upfront decompressive surgery. Many group B and most group C patients achieved long-time LPFS and appeared sufficiently treated with 20 Gy in 5 fractions. However, based on previous data, long-term survivors may benefit from longer-course RT.

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Cancer in the Very Elderly and Management

Thiruthaneeswaran

Morris

Jayamohan

2018

Advanced Age Geriatric Care

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SCORAD III: Randomized noninferiority phase III trial of single-dose radiotherapy (RT) compared to multifraction RT in patients (pts) with metastatic spinal canal compression (SCC).

Cited by 12 publications

References 0 publications

COVID-19: hypofractionation in the Radiation Oncology Department during the “State of Alarm”: first 100 patients in a private hospital in Spain

COVID-19: hypofractionation in the Radiation Oncology Department during the “State of Alarm”: first 100 patients in a private hospital in Spain

A scoring system to predict local progression-free survival in patients irradiated with 20 Gy in 5 fractions for malignant spinal cord compression

Cancer in the Very Elderly and Management

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