2017 ASCO Annual Meeting!
Session: Patient and Survivor Care
Type: Oral Abstract Session
Time: Friday June 2, 3:00 PM to 6:00 PM
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).
Symptom Management/Supportive Care/Palliative Care
Patient and Survivor Care
2017 ASCO Annual Meeting
J Clin Oncol 35, 2017 (suppl; abstr LBA10004)
Author(s): Peter Hoskin, Vivek Misra, Kirsten Hopkins, Tanya Holt, Gillian Brown, Seonaid Arnott, Sharon Shibu Thomas, Krystyna Reczko, Sandy Beare, Andre Lopes, Sharon Forsyth; Mount Vernon Cancer Centre, Middlesex, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; International Atomic Energy Agency, Vienna, Austria; Princess Alexandra Hospital, University of Queensland, Brisbane, Australia; Weston Park Hospital, Sheffield, United Kingdom; Raigmore Hospital, Inverness, United Kingdom; Southend University Hospital NHS Foundation Trust, Southend, United Kingdom; Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
Background: SCC is a common complication of metastatic cancer. Most pts receive RT to improve neurological function and mobility and to relieve pain. There is no standard schedule (RT ranges from single dose 8Gy to 40Gy in 20 fractions). SCORAD III was conducted to show whether a single fraction is as effective as multifraction RT without compromising patient outcomes. Methods: Pts from 43 UK and 4 Australian sites were randomized (1:1) to receive external beam spinal canal RT as a single dose of 8Gy or 20Gy in 5 fractions; stratified by RT center, ambulatory status (AS), site of primary, and presence or absence of nonskeletal metastases. Eligible pts had spinal cord or cauda equina (C1-S2) compression confirmed by MRI/CT scan, treatable within a single radiation field, life expectancy >8 weeks (wks), no previous RT to the same area. Primary endpoint was AS at wk 8: graded 1 (full function) to 4 (no/flicker motor power). The noninferiority margin was 11% for comparing the proportion of patients with AS 1 or 2 at wk 8 (whether maintained from baseline or improved from AS 3-4). Results: 688 pts were randomized Feb 2008 to Apr 2016 (n=345 single dose, n=343 multifraction). 73% were male; median age 70 years; ambulatory with/without walking aids 66%; 44% prostate, 18% lung, 11% breast, 11% gastrointestinal. Baseline characteristics were balanced. 69.5% (114/164 pts evaluable at wk 8) single dose vs. 73.3% (129/176) multifraction had AS 1-2 at wk 8 (risk difference: -3.78%, 90%CI -11.85 to 4.28). Importantly, overall survival (OS) was very similar: median OS 12.4 wks single dose vs. 13.7 multifraction, (hazard ratio 1.02 [95%CI 0.86-1.21], p=0.81). Proportion of pts with adverse events was similar for grade 3-4 (20.6% single dose vs. 20.4% multifraction), but grade 1-2 events were lower with single dose (51.0% vs. 56.9%). Conclusions: Using a single dose of 8Gy in pts with metastatic SCC was as effective as multiple fractions for AS at 8 wks and OS. We now recommend using single dose RT in this setting, with the major benefit of requiring only a single instead of multiple hospital visits, important when considering the short survival in these pts. Clinical trial information: 97108008.
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