title: Radiotherapy With 4 Gy × 5 Versus 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression: Final Results of the SCORE-2 Trial (ARO 2009/01).
abstract: OBJECTIVE
  To compare short-course radiotherapy (RT) (4 Gy × 5) to longer-course RT (3 Gy × 10) for metastatic epidural spinal cord compression (MESCC).
  
  
  METHODS
  Two-hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy × 5 in 1 week (n = 101) or 3 Gy × 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 × 5 and 89.6% after 3 Gy × 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 × 5 and 81.8% after 3 Gy × 10 (P = .51); 6-month overall survival was 42.3% and 37.8% (P = .68).
  
  
  CONCLUSIONS
  Short-course RT with 4 Gy × 5 was not significantly inferior to 3 Gy × 10 in patients with MESCC and poor to intermediate expected survival.
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ. rades.dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Barbara
authors.initials: B
authors.lastname: Šegedin
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Conde-Moreno
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Raquel
authors.initials: R
authors.lastname: Garcia
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Ana
authors.initials: A
authors.lastname: Perpar
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Michaela
authors.initials: M
authors.lastname: Metz
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Harun
authors.initials: H
authors.lastname: Badakhshi
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schreiber
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Mirko
authors.initials: M
authors.lastname: Nitsche
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Peter
authors.initials: P
authors.lastname: Hipp
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schulze
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Irenaeus A
authors.initials: IA
authors.lastname: Adamietz
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Darius
authors.initials: D
authors.lastname: Norkus
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Jon
authors.initials: J
authors.lastname: Cacicedo
authors.affiliation: Dirk Rades, University of Lübeck, Lübeck; Michaela Metz, University of Würzburg, Würzburg; Harun Badakhshi, Charite Berlin, Berlin; Andreas Schreiber, Radiotherapy Practice Dresden-Friedrichstadt, Dresden; Mirko Nitsche, Center of Radiotherapy, Bremen; Peter Hipp, University of Regensburg, Regensburg, and Oberschwabenklinik, Ravensburg; Wolfgang Schulze, Klinikum Bayreuth, Bayreuth; Irenaeus A. Adamietz, Ruhr University Bochum, Bochum, Germany; Barbara Šegedin and Ana Perpar, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Antonio J. Conde-Moreno and Raquel Garcia, Consorcio Hospital Provincial de Castellón, Castellón; Jon Cacicedo, Cruces University Hospital, Barakaldo, Vizcaya, Spain; Darius Norkus, University of Vilnius, Vilnius, Lithuania; Volker Rudat, Saad Specialist Hospital, Al-Khobar, Saudi Arabia; and Steven E. Schild, Mayo Clinic, Scottsdale, AZ.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D015174:Epidural Neoplasms / Q000150:complications* / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D051346:Mobility Limitation; D013117:Spinal Cord Compression / Q000209:etiology* / Q000503:physiopathology; D015996:Survival Rate; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology