Stereotactic Body Radiation Therapy Boost Following Urgent 3D Conformal Radiation Therapy for Metastatic Epidural Spinal Cord Compression: A Phase 1 Feasibility Study
Abstract
Purpose: Palliative 3D-conformal radiation therapy (3D CRT) is the standard treatment for metastatic epidural spinal cord compression (MESCC) in nonsurgical candidates, but pain, motor, and neurologic outcomes are variable. We conducted a pilot study to determine feasibility of stereotactic body radiation therapy (SBRT) boost following 3D CRT and characterize impact on outcomes.
Methods and materials: Eligible patients included those with a solid malignancy, evidence of at least Bilsky 1b MESCC, and Rades motor scale function of at least 3. Patients were initially treated with 3D CRT (either 20 Gy/5 or 8 Gy/1) followed by SBRT boost within 6 weeks to a dose of 18 to 24 Gy/2. The primary outcome was feasibility of planning and delivery of 3D CRT and SBRT boost, with a success rate defined as 80% of accrued patients (95% CI, 75%-97%).
Results: Sixteen patients were initially accrued from 2018 to 2022. Thirteen patients were treated successfully with SBRT boost following 3D CRT, meeting the primary outcome (0.81, 0.57-0.93). Motor function was maintained in 76.9% and improved by 2 points from baseline in 15.4% of patients at 1-month post-SBRT . Ambulatory function improved at 1, 3, and 6 months post-SBRT in 15.4%, 18.2%, and 12.5% of patients respectively. Pain improved in 7.7%, 27.3%, and 37.5% of patients at 1, 3, and 6 months. Only 1 grade 3 toxicity (chest wall pain) occurred, which resolved at 3 months. Median global quality of life using European Organization of Research…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
Read the paper
Related studies
- Preliminary Toxicity Analysis of 3DCRT versus IMRT on the High Dose Arm of the RTOG 0126 Prostate Cancer Trial
- Adaptive Radiotherapy for Head and Neck Cancer: Initial Clinical Outcomes from a Prospective Trial
- American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology
- Motion Management Strategies and Technical Issues Associated with Stereotactic Body Radiotherapy of Thoracic and Upper Abdominal Tumors: A Review from NRG Oncology
- High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial
- Highly efficient training, refinement, and validation of a knowledge-based plan quality control system for radiotherapy clinical trials
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.