| Study/trial | Population | Intervention | Comparison | Outcomes |
|---|---|---|---|---|
|
Hoskin 2019 (SCORAD-III trial) RCT Australia and United Kingdom |
N=686. Patients with MRI or CT confirmed metastatic spinal cord compression. Age, median, years (range): single fraction 70 (23 to 96); multiple fraction 70 (33 to 95). Mean and SD not reported. Sex: female n=183, male n=503. |
Single fraction RT 8 Gy in 1 fraction beginning on day of simulation. |
Multiple fraction RT 20 Gy in 5 fractions. |
|
|
RCT United States |
N=235. Patients with painful spinal metastases. Age, median, years (range): Single fraction 69 (36 to 92); multiple fraction 68 (33 to 91). Mean and SD not reported. Sex: female n=105, male n=129. |
Single fraction RT 8 Gy in 1 fraction. |
Multiple fraction RT 30 Gy in 10 fractions. |
|
|
RCT Ireland and Northern Ireland |
N=104. Patients with MRI documented metastatic spinal cord compression/cauda equina not proceeding with surgical decompression. Age, mean, years (SD): 66.7 (13.1) (not reported by group). Sex: female n=38, male n=66. |
Single fraction RT 10 Gy in 1 fraction beginning on day of simulation. |
Multiple fraction RT 20 Gy in 5 fractions beginning on day of simulation. |
|
|
RCT India |
N=64. Patients with histopathologically proven primary malignancy having symptomatic secondary deposits to the vertebra. Age, median, years (range): multiple fraction 58 (55.64); single fraction 60 (56.64). Mean and SD not reported. Sex: female n=11, male n=53. |
Single fraction RT 8 Gy in 1 fraction. |
Multiple fraction RT 30 Gy in 10 fractions. |
|
|
RCT Italy |
N=300 randomised (n=276 assessable). Patients with MRI or CT diagnosed metastatic spinal cord compression and short life expectancy. Age, median, years (range): short course 66 (30-87); split course 68 (34-89). Mean and SD not reported. Sex: female n=85, male n=191. |
Short course RT 16 Gy in 2 fractions over 1 week. |
Split course RT 30 Gy in 8 fractions over 2 weeks. |
|
|
RCT Italy |
N=303. Patients with MRI or CT confirmed metastatic spinal cord compression with a short life expectancy. Age, median, years (range): single fraction 67 (33-87); multiple fraction 67 (39-87). Mean and SD not reported. Sex: female n=106, male n=197. |
Single fraction RT 8 Gy in 1 fraction. |
Split course RT 16 Gy in 2 fractions. |
|
|
RCT United States |
N=101. Patients with metastatic spinal cord compression. Age, median, years (range): Surgery + RT 60; RT only 60. No further details reported. Sex: female n=31, male n=70. |
Surgery plus radiotherapy Direct decompressive surgery within 24 hours of randomisation followed by RT (30 Gy in 10 fractions administered 14 days after surgery). |
Radiotherapy only 30 Gy in 10 fractions beginning within 24 hours of randomisation. |
|
|
Rades 2016, Rades 2018, Rades 2019 (SCORE-2 trial) RCT Germany |
N=203. Patients with MRI or CT confirmed metastatic spinal cord compression but no previous surgery or radio-therapy to spinal cord. Poor or intermediate survival prognosis. Age, years, n: ≤ 68 n=103, ≥ 68 n=100. Mean and SD not reported. Sex: female n=79, male n=124. | 20 Gy in 5 fractions | 30 Gy in 10 fractions |
|
|
RCT Australia, New Zealand, United Kingdom |
N=272. Patients with painful spinal metastases and life expectancy of at least 6 weeks. Age, median, years (range): single fraction 67 (29-86); multiple fraction 68 (32-89). Mean and SD not reported. Sex: female n=76, male n=196. |
Single fraction RT 8 Gy in 1 fraction. |
Multiple fraction RT 20 Gy in 5 fractions. |
|
|
RCT Canada and Australia |
N=229. Patients with painful MRI-confirmed spinal metastases. Age, n: 18 to 59 n=83; 60 to 69 n=61; ≥70: n=85. Sex: female n=109, male n=120. |
Stereotactic ablative body RT 24 Gy in 2 consecutive daily fractions. |
Conventional RT 20 Gy in 5 daily fractions. |
|
|
Sprave 2018a, b, c (IRON-1 trial) RCT Germany |
N=60. Patients with spinal metastases with indication for palliative radio-therapy. Age, mean, years (SD): IMRT: 66.1 (10.5); conventional RT: 62.5 (11.8). Sex: female n=27, male n=33. |
Image guided intensity modulated RT (IMRT) 30 Gy in 10 fractions. |
Conventional RT 30 Gy in 10 fractions |
|
|
Sprave 2018d, e, f (NCT-02358720) RCT Germany |
N=55 Histologically confirmed tumour diagnosis, with secondary diagnosed solitary/multiple spinal bone metastases and indication for radio-therapy of the spinal bone metastases. Age, mean, years (SD): Stereotactic body RT 61 (8.2); conventional RT 63.9 (10.8). Sex: female n=27, male n=28. |
Stereotactic ablative body RT High dose singlefraction stereotactic ablative body radiation therapy (24 Gy to the 80% isodose line). |
Conventional RT 30 Gy in 10 fractions. |
|
|
Steenland 1999 (Dutch Bone Metastasis trial) RCT Netherlands |
N=1157. Patients with painful bone metastases from a solid tumour. Age, mean, years (SD): single fraction 65 (SD not reported); multiple fraction 65 (SD not reported). Sex: female n=533, male n=624. |
Single fraction RT 8 Gy in 1 fraction. |
Multiple fraction RT 24 Gy in 6 fractions. |
|
CT: computed tomography; Gy: Gray; IMRT: image guided intensity modulated radiotherapy; RCT: randomised controlled trial; MRI, magnetic resonance imaging; RT: radiotherapy, SD: standard deviation.
From: Evidence reviews for radiotherapy
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