Multifraction radiotherapy beats single-fraction radiotherapy in improving ambulatory status in patients with metastatic spinal canal compression, according to the latest results from the SCORAD trial.
The multicentre noninferiority randomised clinical trial was conducted in 42 UK and 5 Australian radiotherapy centres and included 686 eligible patients with metastatic cancer and spinal cord or cauda equina compression, who had life expectancy >8 weeks, and no previous radiotherapy to the same area.
Participants were randomised to receive external beam single-fraction 8 Gy radiotherapy (n=345) or 20 Gy of radiotherapy in five fractions over five consecutive days (n=341).
The primary endpoint was ambulatory status at week 8, based on a four-point scale and classified as grade 1 (ambulatory without the use of aids and grade 5 of 5 muscle power); or grade 2 (ambulatory using aids or grade 4 of 5 muscle power).
Of the cohort (73% men), 44% had prostate cancer, 19% had lung cancer, and 12% had breast cancer.
Ambulatory status grade 1 or 2 at week 8 was achieved by 115 of 166 (69.3%) patients in the single-fraction group vs 128 of 176 (72.7%) in the multifraction group (P value for noninferiority =0.06). The difference in ambulatory status grade 1 or 2 in the single-fraction vs multifraction group was -0.4% (P value for noninferiority =0.004) at week 1, -0.7% (P value for noninferiority =0.01) at week 4, and 4.1% (P value for noninferiority =0.002) at week 12.
Overall survival rates at 12 weeks were 50% in the single-fraction group vs 55% in the multifraction group (stratified HR 1.02; 95% CI 0.74-1.41).
The between group differences for 11 other secondary endpoints did not meet noninferiority criterion.
The study is published in JAMA.
