Top Line: Can more durable radiation doses be delivered even for high-grade malignant cord compression that cannot be surgically debulked?
The Study: This retrospective review of 143 patients receiving “SBRT” for ESCC 2-3 malignant cord compression at Johns Hopkins between 2009-2020 evaluated the success of this approach for such high risk disease. You might be asking: how can you deliver SBRT when there’s zero space between the target and cord? This paper doesn’t go into too much detail other than to note standard SBRT contouring volumes with standard constraints on a 2 mm-cord PRV, but importantly a solid fifth of subjects were prescribed only 25 Gy in 5 fractions. Other common prescriptions were 30 Gy in 5 fractions (28%), 27 Gy in 3 fractions (18%) and 24 Gy in 3 fractions (15%). Cumulative rates of local recurrence were roughly 7% at 1 year and 14% at 2 years. Over two-thirds of patients achieved an improvement in pain at 6 months, with a complete response in 56% and a partial response in 13%. At the same time, a quarter had an improvement in ambulation with almost no patient experiencing worse ambulation. No patient experienced myelopathy nor any grade 3+ toxicity.
TBL: Highly-conformal radiation which allows for dose-escalation is an effective and well-tolerated palliative treatment for high-grade malignant cord compression. | Patel, Adv Radiat Oncol 2023
The Study: This retrospective review of 143 patients receiving “SBRT” for ESCC 2-3 malignant cord compression at Johns Hopkins between 2009-2020 evaluated the success of this approach for such high risk disease. You might be asking: how can you deliver SBRT when there’s zero space between the target and cord? This paper doesn’t go into too much detail other than to note standard SBRT contouring volumes with standard constraints on a 2 mm-cord PRV, but importantly a solid fifth of subjects were prescribed only 25 Gy in 5 fractions. Other common prescriptions were 30 Gy in 5 fractions (28%), 27 Gy in 3 fractions (18%) and 24 Gy in 3 fractions (15%). Cumulative rates of local recurrence were roughly 7% at 1 year and 14% at 2 years. Over two-thirds of patients achieved an improvement in pain at 6 months, with a complete response in 56% and a partial response in 13%. At the same time, a quarter had an improvement in ambulation with almost no patient experiencing worse ambulation. No patient experienced myelopathy nor any grade 3+ toxicity.
TBL: Highly-conformal radiation which allows for dose-escalation is an effective and well-tolerated palliative treatment for high-grade malignant cord compression. | Patel, Adv Radiat Oncol 2023