Kaitlyn D’Onofrio

DocwireNews

A new study evaluated ambulatory outcomes between single-fraction radiotherapy versus multifraction <a href="https://www.docwirenews.com/docwire-pick/hem-onc-picks/immunotherapy-tolerable-after-chemoradiotherapy-in-cervical-cancer-patients/">radiotherapy</a> among patients with spinal canal compression as a result of metastatic <a href="https://www.docwirenews.com/docwire-pick/hem-onc-picks/avoiding-mastectomy-in-recurrent-breast-cancer/">cancer</a>.&ldquo;Malignant spinal canal compression, a major complication of metastatic cancer, is managed with <a href="https://www.docwirenews.com/docwire-pick/future-of-medicine-picks/treating-prostate-cancer-with-5-radiotherapy-sessions/">radiotherapy</a> to maintain mobility and relieve pain, although there is no standard radiotherapy regimen,&rdquo; posited the study authors. Therefore, the researchers questioned &ldquo;whether single-fraction radiotherapy is noninferior to 5 fractions of radiotherapy.&rdquo;The findings of the study&mdash;a multicenter, noninferiority, randomized clinical trial&mdash;were published in <a href="https://jamanetwork.com/journals/jama/article-abstract/2756290">JAMA</a>.The study took place at 42 UK and five Australian radiotherapy centers and included 686 metastatic cancer patients with spinal cord or cauda equina compression, who were recruited from February 2008 through April 2016. Other eligibility criteria included life expectancy greater than eight weeks and no history of radiotherapy to the same area. Final follow-up was performed in September 2017. Patients randomly received either external beam single-fraction 8-Gy radiotherapy (n&thinsp;=&thinsp;345) or 20 Gy of radiotherapy in five fractions over five consecutive days (n&thinsp;=&thinsp;341). The primary outcome measure was eight-week ambulatory status per a four-point scale, with grade 1 defined as &ldquo;ambulatory without the use of aids and grade 5 of 5 muscle power&rdquo; and grade 2 as &ldquo;ambulatory using aids or grade 4 of 5 muscle power.&rdquo; The authors classified the noninferiority margin for the ambulatory status difference as &ndash;11%. Other outcomes were one-, four-, and 12-week ambulatory status, as well as overall survival.Of the initial 686 patients who were randomized (median [interquartile range] age, 70 [64 to 77] years; 503 [73%] were male), most (44%) had prostate cancer; 19% had lung cancer and 12% had breast cancer. In total, 255 patients died prior to the eight-week assessment. Just about half of the total initial cohort (n = 342, 49.8%) was analyzed for the primary outcome. Of the patients available for analysis, in the single-fraction group (n = 166), eight-week ambulatory status grade 1 or 2 was attained by 115 patients (69.3%); 176 patients in the multifraction group were available for eight-week analysis, of whom 128 (72.7%) achieved ambulatory status grade 1 or 2 (difference, &minus;3.5% [one-sided 95% CI, &minus;11.5% to &infin;];&nbsp;P&nbsp;value for noninferiority&thinsp;=&thinsp;0.06). Regarding the secondary outcomes, the study authors reported: &ldquo;The difference in ambulatory status grade 1 or 2 in the single-fraction vs multifraction group was &minus;0.4% (63.9% vs 64.3%; [1-sided 95% CI, &minus;6.9 to &infin;];&nbsp;P&nbsp;value for noninferiority&thinsp;=&thinsp;.004) at week 1, &minus;0.7% (66.8% vs 67.6%; [1-sided 95% CI, &minus;8.1 to &infin;];&nbsp;P&nbsp;value for noninferiority&thinsp;=&thinsp;.01) at week 4, and 4.1% (71.8% vs 67.7%; [1-sided 95% CI, &minus;4.6 to &infin;];&nbsp;P&nbsp;value for noninferiority&thinsp;=&thinsp;.002) at week 12.&rdquo; The 12-week overall survival rate was lower in the single-fraction group than the multifraction group (50% vs. 55%; stratified hazard ratio, 1.02 [95% CI, 0.74 to1.41]). Other secondary outcomes did not largely differ between the groups or did not meet noninferiority criterion.&ldquo;We believe our findings, which show equal clinical effectiveness for single-dose radiotherapy, provide strong evidence for [National Institute for Health and Care Excellence] guidelines, and those in other countries, to be changed to stipulate a one-dose one-visit approach, reducing unnecessary discomfort for end of life cancer patients without compromising efficacy,&rdquo; said lead study investigator professor Peter Hoskin, of the University of Manchester, Mount Vernon Cancer Centre (NHS), <a href="https://cswnews.sharepoint.com/:w:/s/AMCDigitalTeam/EW4M9Xc4ke1GvIvkfi6cx7QB-5mOdGF9xQDBZrBzs3XEPA">in a press release</a>.

Jordana Jampel

Cutaneous Melanoma: Sun Protection Behaviors and UV Exposure in Canada

Melanoma

Leah Lawrence

Significant Cardiac Benefit Seen With Ifetroban in Patients With Duchenne Muscular Dystrophy

Neurology

Apitegromab Improved Motor Function in Type 2/3 Spinal Muscular Atrophy

Latest News

Study Compares Single- vs. Multifraction Radiotherapy for Spinal Canal Compression from Metastatic Cancer

Oncology

A new study evaluated ambulatory outcomes between single-fraction radiotherapy versus multifraction radiotherapy among patients with spinal canal compression as a result of ...

Study Compares Single- vs. Multifraction Radiotherapy for Spinal Canal Compression from Metastatic

About Us

Editorial Policy

Advertising

Contact Us

eNewsletters

Contribute

Career Center

MashupMD

Blood Cancers Today

Cancer Nursing Today

GU Oncology Now

Urban Health Today

Anemia

Deep Vein Thrombosis

Essential Thrombocythemia

Hemophilia

Immune Thrombocytopenic Purpura

Myelodysplastic Syndromes

Myelofibrosis

Myeloproliferative Neoplasms

Polycythemia Vera

Pulmonary Embolism

Sickle Cell Disease

Thrombocytopenia

Thrombophilia

Thrombosis

Thrombotic Thrombocytopenic Purpura

Venous Thromboembolism

von Willebrand Disease

Heme Today

Acute Kidney Injury

ADPKD

Anemia and Kidney Disease

Chronic Kidney Disease

COVID-19 and Kidney Disease

Diabetes and Hypertension

End-Stage Renal Disease

Gout

Hyperkalemia

IgAN

Kidney Transplantation

Metabolic Acidosis

Nephrology Times

HER2 Breast Cancer

HR Breast Cancer

Triple-Negative Breast Cancer

Genetics & Breast Cancer

Breast Cancers Today

Atherosclerotic Disease

Atrial Fibrillation

Heart Failure

Hypertension

Interventional Cardiology

Lipid Management

Practice Tips With Dr. Lichaa

Preventive Cardiology

Stroke

Cardiology

Breast Cancer

Gynecologic Cancer

Head and Neck Cancer

Skin Cancer

Sleep

Urology

Diabetes

Ophthalmology

— Demodex Blepharitis

Rheumatology

Gastroenterology

Pulmonology

Infectious Diseases

— HIV

Health and Wellness

Lupus

Future of Medicine

Orthopedics

Pharmacology

Career News

More

Conferences

CardioNerds

The Sleep Source With Dr. Morse

Rheumatology Rounds With Dr. Maheswaranathan

Partners

Expert Interviews

Subscribe