TY - JOUR
T1 - Efficacy and toxicity of primary re-irradiation for malignant spinal cord compression based on radiobiological modelling
T2 - a phase II clinical trial
AU - Wallace, Neil D.
AU - Dunne, Mary T.
AU - McArdle, Orla
AU - Small, Cormac
AU - Parker, Imelda
AU - Shannon, Aoife M.
AU - Clayton-Lea, Angela
AU - Parker, Michael
AU - Collins, Conor D.
AU - Armstrong, John G.
AU - Gillham, Charles
AU - Coffey, Jerome
AU - Fitzpatrick, David
AU - Salib, Osama
AU - Moriarty, Michael
AU - Stevenson, Michael R.
AU - Alvarez-Iglesias, Alberto
AU - McCague, Michael
AU - Thirion, Pierre G.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2023/2/16
Y1 - 2023/2/16
N2 - Background: The efficacy and safety of primary re-irradiation for MSCC are not known. Our aim was to establish the efficacy and safety of biologically effective dose-based re-irradiation. Methods: Patients presenting with MSCC at a previously irradiated spine segment, and not proceeding with surgical decompression, were eligible. A 3 Gray per fraction experimental schedule (minimum 18 Gy/6 fractions, maximum 30 Gy/10 fractions) was used, delivering a maximum cumulative spinal dose of 100 Gy2 if the interval since the last radiotherapy was within 6 months, or 130 Gy2 if longer. The primary outcome was a change in mobility from week 1 to week 5 post-treatment, as assessed by the Tomita score. The RTOG SOMA score was used to screen for spinal toxicity, and an MRI performed to assess for radiation-induced myelopathy (RIM). Results: Twenty-two patients were enroled, of whom eleven were evaluable for the primary outcome. Nine of eleven (81.8%) had stable or improved Tomita scores at 5 weeks. One of eight (12.5%) evaluable for late toxicity developed RIM. Conclusions: Re-irradiation is an efficacious treatment for MSCC. There is a risk of RIM with a cumulative dose of 120 Gy2. Clinical Trial Registration: Cancer Trials Ireland (ICORG 07-11); NCT00974168.
AB - Background: The efficacy and safety of primary re-irradiation for MSCC are not known. Our aim was to establish the efficacy and safety of biologically effective dose-based re-irradiation. Methods: Patients presenting with MSCC at a previously irradiated spine segment, and not proceeding with surgical decompression, were eligible. A 3 Gray per fraction experimental schedule (minimum 18 Gy/6 fractions, maximum 30 Gy/10 fractions) was used, delivering a maximum cumulative spinal dose of 100 Gy2 if the interval since the last radiotherapy was within 6 months, or 130 Gy2 if longer. The primary outcome was a change in mobility from week 1 to week 5 post-treatment, as assessed by the Tomita score. The RTOG SOMA score was used to screen for spinal toxicity, and an MRI performed to assess for radiation-induced myelopathy (RIM). Results: Twenty-two patients were enroled, of whom eleven were evaluable for the primary outcome. Nine of eleven (81.8%) had stable or improved Tomita scores at 5 weeks. One of eight (12.5%) evaluable for late toxicity developed RIM. Conclusions: Re-irradiation is an efficacious treatment for MSCC. There is a risk of RIM with a cumulative dose of 120 Gy2. Clinical Trial Registration: Cancer Trials Ireland (ICORG 07-11); NCT00974168.
UR - https://www.scopus.com/pages/publications/85143662501
U2 - 10.1038/s41416-022-02078-w
DO - 10.1038/s41416-022-02078-w
M3 - Article
C2 - 36482188
AN - SCOPUS:85143662501
SN - 0007-0920
VL - 128
SP - 576
EP - 585
JO - British Journal of Cancer
JF - British Journal of Cancer
IS - 4
ER -
