Critical appraisal:Freundt K, Meyners T, Bajrovic A, Basic H, Karstens JH, Adamietz IA, et al 2010

Critical Appraisal

Article being appraised

Freundt K, Meyners T, Bajrovic A, Basic H, Karstens JH, Adamietz IA, et al. Radiotherapy for oligometastatic disease in patients with spinal cord compression (MSCC) from relatively radioresistant tumors. Strahlenther Onkol 2010 Apr;186(4):218-23 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20354660.

Applicable clinical question

When is radiotherapy indicated for patients with distant metastasis?

Key Facts

Study Design

cohort study

Study aims:

To compare 30 Gy in 10 fractions to higher doses (37.5 Gy in 15 fractions or 40 Gy in 20 fractions).

Number of Patients:

51

30 Gy in 10 fractions: 21
higher doses: 30

Reported outcome(s):

post-treatment motor function
local control of metastatic spinal cord compression
survival

Results of outcome(s):

>post-treatment motor function:
overall - improvement in motor function = 23 ppts (45%), stable motor function = 23 ppts (45%), deterioration in motor function = 10 ppts (10%)
radiation regimen had no significant impact on post-treatment motor function, p=0.44 (univariate)
>local control of metastatic spinal cord compression:
radiation regimen was not significantly associated with local control, p=0.75 (univariate)
>survival:
overall median survival - 18.5 mo
radiation regimen was not associated with survival, p=0.52 (univariate)

>>time to developing motor deficients was not associated with survival (RR: 1.47, 95%CI 0.76-2.71, p=0.24

Includes an economic evaluation

no