On a scale of 5 to 10.

What’s the ideal radiation regimen to go with for spinal cord compression? The SCORE-2 trial demonstrated non-inferiority in numerous clinical outcomes with 20 Gy in 5 fractions compared to 30 Gy in 10 fractions for epidural spinal cord compression in patients with poor-to-intermediate prognosis. By the way, this group has previously demonstrated that disease control and perhaps even survival appear superior with >30 Gy in 10 fractions for favorable prognosis patients. Here we have the secondary analysis of patient-reported outcomes--most notably pain control. When it came to distress relief and pain relief, there was no significant difference between arms at 1 month. Complete pain relief rates were 20-25% while overall pain relief rates were 50-60%. In this population, survival rates were too low at 6 months to draw meaningful comparisons between groups. TBL: In patients with poor or intermediate prognosis and metastatic spinal cord compression, 4 Gy x 5 is just as effective as 3 Gy x 10 at relieving patient reported pain and distress. | Rades, Int J Radiat Oncol Biol Phys, 2019