Metastatic spinal cord compression (MSCC) is a serious complication to metastatic cancer and when diagnosed life expectancy is short. Treatment is palliative radiotherapy (RT). Early esophageal toxicity is underreported but can seriously impact quality of life (QoL). The aim of the ESO-SPARE trial is to investigate if esophagus sparing RT can decrease patient reported esophageal toxicity without compromising ambulatory function or increase other toxicities. 200 patients with MSCC in the thoracic or cervical spine referred for RT will be randomized to either standard or esophagus/pharynx sparing RT. Subsequently participants will be followed with PROM (Patient Reported Outcome Measures) for 9 weeks. PROM-CTCAE questionnaires on upper GI toxicity and pain will be collected daily for 5 weeks and weekly for 4 weeks. Questionnaires evaluating QoL and physical function will be collected weekly for 9 weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
200
A radiotherapy plan for metastatic spinal cord compression is conducted with specific constrains sparring the esophagus.
Rigshospitalet
Copenhagen, Denmark
RECRUITINGHerlev Hospatal
Herlev, Denmark
RECRUITINGEarly patient reported gastro-oesophageal toxicity
Measured as a peak score using CTCAE Patient Reported Outcome Measures
Time frame: Measured within the first 5 weeks after treatment start
Ambulatory function
Preserved ability to walk will be evaluated using the European Quality of Life - 5 Dimensions questionnaire (EQ-5D-5L) mobility dimension. The EQ-5D includes one question for each of the five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has five response levels: no problems (Level 1); slight; moderate; severe; and extreme problems (Level 5).
Time frame: Measured 9 weeks after treatment start
Duration of gastro-oesophageal toxicity
Measured as the time from an increase in gastro-oesophageal symptom score to a return to baseline
Time frame: Assessed 9 weeks after treatment start
Reirradiation rate - Overall survival (OS)
Defined as fraction of patients getting reirradiation, where the same spine levels are included in the irradiated volume
Time frame: Assessed 6 months after inclusion of the last patient.
Patient reported physical function
Patient reported physical function will be assessed using answers from the EORTC QLQ-C30 questionnaire. Questions regarding physical function are measured on a four-point scale (1= not at all, 2 = a little, 3 = quite a bit, 4 = very much). All EORTC QLQ-C30 answers will be scored according to the EORTC QLQ-C30 Scoring Manual.
Time frame: Assessed Weekly over a period of 9 weeks
Health related Quality of life (QoL)
Health related quality of life measured with EQ-5D-5L European Quality of Life - 5 Dimensions questionnaire (EQ-5D-5L). The EQ-5D includes one question for each of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has five response levels: no problems (Level 1); slight; moderate; severe; and extreme problems (Level 5). Health state scores are defined by combining one level from each dimension, ranging from 11111 (full health) to 55555 (worst health). A visual analogue scale indicating the respondent's own assessment of their health status from 0-100 is also included (100 = the best health you can imagine and 0 = the worst health you can imagine).
Time frame: Assessed Weekly over a period of 9 weeks
Health related Quality of life (QoL)
Health related quality of life assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of life Questionnaire - Cancer (QLQ-C30). The EORTC QLQ-C30 consists of 30 questions assessing quality of life issues using a four-point scale (1= not at all, 2 = a little, 3 = quite a bit, 4 = very much) except from the last two questions which are measured between 1 (Very Poor) to 7 (Excellent). The EORTC QLQ-C30 will be scored according to the EORTC QLQ-C30 Scoring Manual.
Time frame: Assessed Weekly over a period of 9 weeks
Weight
Assessed Weekly over a period of 9 weeks
Time frame: Assessed Weekly over a period of 9 weeks
Analgesic consumption
Assessed Weekly over a period of 9 weeks
Time frame: Assessed Weekly over a period of 9 weeks
Pain (MSCC site)
Evaluated by "Numeric Pain Rating Scale (NPRS)" The scale is composed of 0 (no pain at all) to 10 (worst imaginable pain).
Time frame: Assessed daily for 5 weeks and subsequently weekly for 4 weeks.
Pain assessment (MTS site)
Assessment will be performed using International Consensus Pain Response Endpoints (ICPRE). * A complete pain response is defined as a pain score of 0 out of 10 at the treated site with no concomitant increase in analgesic intake * A partial pain response is defined as a pain reduction of 2 or more at the treated site without analgesic increase, or an analgesic reduction of 25% with no increase in pain score or 1 point above baseline. * Pain progression is defined as an increase in pain score of 2 or more above baseline with stable analgesic intake or an analgesic increase of 25% with stable pain score. * An indeterminate response is any response not captured in the above definitions. Analysis of pain reduction will only include patients with NPRS ≥ 1 registered at baseline. We intend to report the best response during follow-up.
Time frame: Best response during 9 weeks of follow-up
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