I firmly believe that 1 x 8 Gy are a bad idea for spinal cord compression. The problem is however that the comparison arm with 5 x 4 Gy is also a bad idea. Actually anything involving radiation therapy with "standard doses" without surgery and spinal cord compression is a bad idea.
I am going overboard here, but "What ethical committee agreed to this trial?"
A patient with a spinal cord compression and an apparent surivival ">8 weeks" according to the inclusion criteria should get SURGERY first. What happened to surgery?
Furthermore look at their OS data... Median survival of 12 weeks for the entire group? That's 3 months... What patients were put on this trial? Bearing in mind that almost half of them where prostate cancer patients, I wonder if we are talking about patients who have failed every single line of available systemic treatment for prostate cancer and then entered the trial. And nowadays if you get metastatic prostate cancer you have something like 6 lines of therapy available...
This pretty much reminds me of the QUARTZ trial for CNS-metastatic NSCLC, where half of the patients were dead within 8 weeks. Kind of hard to show a difference there too, if half of your population is dead within 8 weeks. 8 weeks is the prognosis among the worst of all brain-met patients according to the GPA-scores, yet QUARTZ claimed to have enrolled patients "who couldn't get stereotactic treatment". In the UK you are only entitled to stereotactic treatment if you have one brain lesion and controlled extracranial disease, meaning that probably less than 15% of all brain met patients get stereotactic treatment.
All these NHS-funded trials have one thing in common: flawed designs and clinical outcomes that do not reflect what we see in daily practice.
I have the impression that the "worst of the worst" possible patients are being pushed into these trials.