One dose of radiotherapy ‘as effective as five doses’ for spinal cancer – study

One dose of radiotherapy is as clinically effective as five doses for terminal cancer patients with tumours in the spine, researchers have said.

A study carried out at University College London claims there is not much difference between single and multiple radiotherapy treatments for those who develop spinal canal compression – a common complication that occurs when cancer has spread to the spine, leaving patients in pain and unable to walk.

The researchers said their findings, published in the journal JAMA, could help reduce unnecessary hospital visits for end-of-life cancer patients without compromising the quality of care.

While any type of cancer can spread to the bones of the spine, spinal canal compression is more common in people with breast, lung, blood or prostate cancers.

Around five in 100 people with cancer develop this condition, which equates to around 4,000 people in the UK each year.

Current UK guidelines do not specify a standard treatment regimen for patients with spinal canal compression and the common practice is to offer at least five doses of radiation treatment, with each dose requiring a separate visit to hospital.

While radiotherapy can manage pain and help patients walk, it also has side-effects such as adverse skin reactions and fatigue.

Of the 686 patients involved in the trial, half were randomly assigned to be given just one radiotherapy dose and the other half were given five doses.

Around half (344) of the patients who took part in the trial died before eight weeks.

Among those who were still alive after eight weeks, 69% of the patients who had been given one dose were able to walk compared with 73% of those who had five doses. These results, according to the researchers, are considered close enough clinically.

At week 12, 72% of the patients who had one dose were on their feet, compared with 68% in the five-dose group.

Having additional cancer treatments, supportive care therapies, quality of life and pain were all similar between having one or five doses, the researchers said.

The only exception was a group who had radiation treatment specifically to the lower part of their spinal cord called the cauda equina, where the researchers said one radiotherapy dose might not be enough treatment for these particular patients.

Although around half of patients who took part in the trial died before eight weeks, the researchers said their findings are “supported by all of the other statistical criteria”.

Professor Allan Hackshaw, of the UCL Cancer Institute and study co-author, said: “This is the first large study to assess whether giving a single dose of radiation in one visit is as clinically effective as multiple doses.

“Our trial showed that one dose was just as good as several doses for a range of patient outcomes.”