Treatment compression.

Balancing efficacy, toxicity and burden of treatment time for patients dying with cancer is an art. But does there always have to be a trade-off? The results of the SCORAD trial presented this weekend in abstract form at ASCO conclude that patients with cord compression do not forfeit chances of maintaining or regaining ambulatory status if treated with single-fraction versus multi-fraction radiation. 688 patients with spinal cord compression were randomized to 8 Gy x 1 vs. 4 Gy x 5. Primary outcome was ambulatory status 8 weeks out from radiation with good (grade 1-2) results achieved in 70% vs. 73%. Looks like a quick shot of 8 Gy is the way to go for immediate outcomes, but verdict is still out on the classic counterargument: re-treatment rates.