Spinal Cord Compression Clinical Trial
Official title:
Stereotactic Body Radiotherapy (SBRT) Boost Following Urgent 3D Conformal Radiotherapy in the Treatment of Metastatic Epidural Spinal Cord Compression (SCC): A Phase I Feasibility Trial
Spinal cord compression (SCC) is a devastating complication of advanced malignancy, and can
cause significant deterioration in function and quality of life (QoL). The goal of treatment
is to improve functional status and symptoms, but the optimal treatment regimen for these
patients has not been thoroughly established. Many patients with SCC present with
uncontrolled systemic disease and poor performance status, and are not eligible for standard
surgical resection. They are generally treated with 3D conformal palliative RT (3DCRT) alone,
however recent trials suggest that less than 70% of patients are ambulatory, that the
re-establishment of ambulation in non-ambulatory patients is poor, and the duration of
improvement is guarded with radiotherapy alone.
Recently, stereotactic body radiotherapy (SBRT) used alone or after previous radiotherapy to
treat spinal metastasis has demonstrated superior results in pain control, tumour response
and durability. SBRT requires time for careful planning, and many patients with neurologic
symptoms must be treated immediately to prevent progression. Therefore the role of SBRT is
still unclear in this patient population, although it seems to be a potential alternative to
surgical decompression in patient not suitable for surgery. The investigators propose a
feasibility study to investigate the potential benefits of dose escalation with a sequential
SBRT boost to urgent 3D CRT in the setting of SCC. This regimen will allow inoperable
patients to receive urgent 3DCRT while simultaneously creating the opportunity for superior
outcomes with SBRT. The investigators also aim to characterize the effect on motor function
and ambulation, pain and QoL. This study could stimulate further multi-center randomized
trials in this area, improve motor function and patient-reported QoL, and contribute to
improving oncology care in Canada in a meaningful way.
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