Radiotherapy With 4 Gy X 5 Versus 3 Gy X 10 for Metastatic Epidural Spinal Cord Compression: Final Results of the SCORE-2 Trial (ARO 2009/01)

Purpose To compare short-course radiotherapy (RT) (4 Gy x 5) to longer -course RT (3 Gy x 10) for metastatic epidural spinal cord compression (MESCC). Patients and Methods Two -hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy x 5 in 1 week (n = 101) or 3 Gy x 10 in 2 weeks (n = 102). Patients were stratified according to ambulatory status, time developing motor deficits, and primary tumor type. Seventy-eight and 77 patients, respectively, were evaluable for the primary end point, 1 -month overall response regarding motor function defined as improvement or no further progression of motor deficits. Other study end points included ambulatory status, local progression-free survival, and overall survival. End points were evaluated immediately after RT and at 1, 3, and 6 months thereafter. Results At 1 month, overall response rates regarding motor function were 87.2% after 4 Gy x 5 and 89.6% after 3 Gy x 10 (P =.73). Improvement rates were 38.5% and 44.2%, respectively, no further progression rates 48.7% and 45.5%, respectively, and deterioration rates 12.8% and 10.4%, respectively (P=.44). Ambulatory rates at 1 month were 71.8% and 74.0%, respectively (P=.86). At other times after RT, the results were also not significantly different. Six-month local progression free survival was 75.2% after 4 Gy x 5 and 81.8% after 3 Gy x 10 (P=.51); 6 -month overall survival was 42.3% and 37.8% (P =.68). Conclusion Short -course RT with 4 Gy x 5 was not significantly inferior to 3 Gy x 10 in patients with MESCC and poor to intermediate expected survival. (C) 2016 by American Society of Clinical Oncology