When should you use single-fraction radiotherapy for spinal cord compression?

The SCORAD III trial is practice changing. But I do NOT plan to treat ALL patients with spinal cord compression with a single fraction of 8 Gy now. Here is why: SCORAD III is extremely important new study for the management of metastatic epidural spinal cord compression (MESCC) for patients with short prognosis, but follow-up remains short and I do not think we have adequate data to implement 8 Gy in a single fraction for patients who are likely to survive 6 months or more. Some context:

The SCO...

I wouldn't change practice based solely upon an abstract. However, I believe that the main point of this study as well as others that have investigated the use of 800cGyx1 is that it is appropriate for patients who only require short term benefits from treatment. According to the abstract, the median OS was 12-13 weeks, and the reported endpoint was ambulant status at 8 weeks. Thus in the short term, when the survival expectation is limited, a single fraction of 800cGy may be appropriate.

I honestly have to say that I have not used 800 cGy single fraction in spinal cord compression but I have used it a lot for painful bone metastases. It was good to review the SCORAD III data and I will keep this in mind for my discussion with patients but I think 2000 cGy in 5 fractions will still be my usual recommendation unless the patient cannot come for 5 treatments.

The short answer to this question of using single fraction radiation is yes for all patients who are neurologically intact or who have minimal neurological signs (ie, muscle power ≥ 4/5, functional paresis); one can use single fraction palliative treatment for patients who may have a limited survival expectancy, or spine radiosurgery 18-20 Gy single fraction for radiosurgical decompression of the spinal cord.

The SCORAD III study tested the palliative radiation doses (8 Gy one fraction versus 20G...

I agree that single fraction palliative radiotherapy should be used for patients with malignant epidural spinal cord compression (MESCC). There are now multiple randomized datasets supporting this recommendation. Maranzano et al published a study of 30Gy in 8 fx vs 16 Gy in 2 fx showing no difference in neurologic outcomes including response, duration of response, survival, or toxicity found between the two arms (JCO 2005 http://ascopubs.org/doi/abs/10.1200/JCO.2005.08.193 )

The Maranzano group ...