Should 4 Gy x 5 be the standard of care for spinal cord compression in patients with poor prognosis?

The randomized SCORE-2 trial demonstrated equivalent survival (median 3 vs 3.7 months), response rates (72% vs 74% ambulatory at 1 month), and durability of palliation (~80% of survivors ambulatory at 6 months in both arms) between 4 Gy x 5 and 3 Gy x 10 when treating cord compression in patients with poor prognosis, as defined by a validated prognostic scoring system.

Given that one extra week of RT is a significant investment for those with only 3-4 months median survival, should 4 Gy x 5 be the standard of care in this patient population?

Answer from: Radiation Oncologist at Community Practice

Wow, so this question was asked in 2016 and nobody has taken a whack at it. 30 Gy in 10 fx has been the long-standing standard dose for SCC in most countries for just about ever. This has not been compared to other doses until more recently. 30/10 works well, is relatively short (2 weeks), and util...

Comments

Radiation Oncologist at Mays Cancer Center, UT Health San Antonio MD Anderson Cancer Center
Have you done much 25/5 through the cord with 3D? ...

Radiation Oncologist at Lake Huron Medical Center
Great pub! I think Sloan does the majority of bone...

Radiation Oncologist at Mallory Radiotherapy, PLLC
I would not routinely do this. I have always wonde...

Radiation Oncologist at Lake Huron Medical Center
Very reasonable. I would not do 25/5 AP PA. As t...

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