Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

231 questions · 231 findings · 20 reviews · Pain, Palliative and Supportive Care

No studies found 37 · 16%GRADE not reported 21 · 9.1%Very low 40 · 17.3%Low 80 · 34.6%Moderate 50 · 21.6%High 3 · 1.3%

High‐dose corticosteroids vs moderate‐dose or no corticosteroids

Ambulation · adults with metastatic extradural spinal cord compression (without peptic ulceration or infection; mixed prognosis)

High‐dose corticosteroids showed no clear difference in ambulation compared with moderate‐dose or no corticosteroids (low certainty).

1 finding from 1 review

Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy

Reduction in analgesic and narcotic use One month after radiation · adults with metastatic extradural spinal cord compression (poor prognosis with visceral metastasis, and no spinal instability or bony…

Single‐fraction radiotherapy (8 Gy) showed no clear difference in reduction in analgesic and narcotic use One month after radiation compared with short‐course radiotherapy (16 Gy (moderate certainty).

1 finding from 1 review

High‐dose corticosteroids vs moderate‐dose or no corticosteroids

Survival (long term) Over two years · adults with metastatic extradural spinal cord compression (without peptic ulceration or infection; mixed prognosis)

High‐dose corticosteroids showed no clear difference in survival (long term) Over two years compared with moderate‐dose or no corticosteroids (low certainty).

1 finding from 1 review

High‐dose corticosteroids vs moderate‐dose or no corticosteroids

Pain reduction · adults with metastatic extradural spinal cord compression (without peptic ulceration or infection; mixed prognosis)

High‐dose corticosteroids showed no clear difference in pain reduction compared with moderate‐dose or no corticosteroids (low certainty).

1 finding from 1 review

High‐dose corticosteroids vs moderate‐dose or no corticosteroids

Urinary continence One week after treatment · adults with metastatic extradural spinal cord compression (without peptic ulceration or infection; mixed prognosis)

High‐dose corticosteroids showed no clear difference in urinary continence One week after treatment compared with moderate‐dose or no corticosteroids (low certainty).

1 finding from 1 review

High‐dose corticosteroids vs moderate‐dose or no corticosteroids

Serious adverse events · adults with metastatic extradural spinal cord compression (without peptic ulceration or infection; mixed prognosis)

High‐dose corticosteroids probably leads to higher serious adverse events compared with moderate‐dose or no corticosteroids (moderate certainty).

1 finding from 1 review

Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy

Urinary continence One month after radiation · adults with metastatic extradural spinal cord compression (poor prognosis with visceral metastasis, and no spinal instability or bony…

Single‐fraction radiotherapy (8 Gy) showed no clear difference in urinary continence One month after radiation compared with short‐course radiotherapy (16 Gy (moderate certainty).

1 finding from 1 review

Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy

Local recurrence · adults with metastatic extradural spinal cord compression (poor prognosis with visceral metastasis, and no spinal instability or bony…

Single‐fraction radiotherapy (8 Gy) showed no clear difference in local recurrence MRI: compared with short‐course radiotherapy (16 Gy (low certainty).

1 finding from 1 review

Single‐fraction radiotherapy (8 Gy) vs short‐course radiotherapy (16 Gy

Adverse events Grade 3 oesophagitis, diarrhoea and nausea · adults with metastatic extradural spinal cord compression (poor prognosis with visceral metastasis, and no spinal instability or bony…

Single‐fraction radiotherapy (8 Gy) showed no clear difference in adverse events Grade 3 oesophagitis, diarrhoea and nausea compared with short‐course radiotherapy (16 Gy (moderate certainty).

1 finding from 1 review

Split‐course radiotherapy (8 fractions, 30 Gy) vs short‐course radiotherapy (16 Gy

Ambulation · adults with metastatic extradural spinal cord compression (poor prognosis, no spinal instability or bony impingement of cord)

Split‐course radiotherapy (8 fractions, 30 Gy) showed no clear difference in ambulation One month after treatment compared with short‐course radiotherapy (2 fractions, 16 Gy) (moderate certainty).

1 finding from 1 review

Radioisotopes vs placebo

Complete relief of pain · patients with metastatic bone pain

Radioisotopes probably leads to higher pain relief ‐ Complete relief compared with placebo (moderate certainty).

1 finding from 1 review

Radioisotopes vs placebo

Pain relief ‐ Complete/Partial relief · patients with metastatic bone pain

Radioisotopes probably leads to higher pain relief ‐ Complete/Partial relief compared with placebo (moderate certainty).

1 finding from 1 review

Radioisotopes vs placebo

Compression of spinal cord · patients with metastatic bone pain

Radioisotopes showed no clear difference in compression of spinal cord compared with placebo (low certainty).

1 finding from 1 review

Radioisotopes vs placebo

Pain flares · patients with metastatic bone pain

Radioisotopes showed no clear difference in pain flares compared with placebo (low certainty).

1 finding from 1 review

Radioisotopes vs placebo

Safety (AE, adverse drug reaction): thrombocytopenia Grades 3 or 4 according to National Cancer Institute · patients with metastatic bone pain

Radioisotopes showed no clear difference in thrombocytopenia III‐IV compared with placebo (low certainty).

1 finding from 1 review