Staying single.

Single-fraction radiation is all the rage these days across a number of palliative indications, but the uptake has been slow in the setting of neurologic compromise. The primary fear is durability (or lack thereof), with recurrences of tumors in these locations causing dire consequences. This is despite three prospective randomized trials (including SCORAD-III) all indicating equivalency in cord compression outcomes with a single radiation treatment. Granted criticisms remain about loss of follow-up—but considering these populations, we’d cut the investigators some slack. Enter this meta-analysis of said three trials including 1126 patients, with 712 having sufficient follow-up. Across all trials, about two-thirds of enrollees were ambulatory at baseline, and all were deemed unsuitable for surgery. In the end, hazard ratios for one (8-10 Gy x 1) versus more (4 Gy x 5 or 8 Gy x 2) fractions were pretty darn close to 1 for ambulatory status (HR 0.96), bladder function (HR 1.00), and survival (HR 0.97). There were also no notable differences in descriptors of pain response or toxicity. TBL: There is no high-level evidence that fractionated radiation regimens produce better or more durable recovery of neurologic function than a single fraction treatment for inoperable spinal cord compression. | Donovan, Radiat Oncol 2019