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

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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

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

Evidence ratings

Level of evidence

III-3

Risk of bias
High risk of bias Comments: selected dose population, baseline not significantly different, survival outcomes, non-concurrent controls, all patients accounted for

Risk of bias assessment: cohort study

Subject selection
"New technology" group
Selected group
Comparison group
Selected group
Comparability of groups on demographic characteristics and clinical features
Comparable
Measurement of outcomes
Outcome measures blind to technology used
No, but objective measures used
Same method of measurement used across comparison groups
No or not described
Completeness of follow-up
Was follow-up complete and were all patients included in the analysis?
Yes (follow-up >95%) or survival analysis using all patients
Size of effect
4 Reason for decision: results not significantly different between groups
Relevance of evidence
1 Additional comments: patient-related population
Result of appraisal

Jutta's tick icon.png Included




Completed by

Cecilia Taing


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Article
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.
Assigned to
User:Cecilia.taing
Topic area
Guidelines:Melanoma
Clinical question
Form
Form:Critical appraisal


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