Graham 2006.

Study characteristics
Methods	Pilot randomised controlled trial 8 recruiting centres Study duration: 14 days
Participants	20 participants with malignant spinal cord compression (MSCC) Inclusion criteria: malignant disease at least one of: pain, weakness, sensory symptoms, sphincter problems ECOG performance status ≥ 4 before the MSCC event minimum limb power 1/5 estimated minimum survival of 2 months
Interventions	High‐dose: 96 mg dexamethasone intravenously day 0, continued to day 2 then weaned to 0 by day 15 or Low‐dose: 16 mg dexamethasone intravenously day 0, continued to day 2 then weaned to 0 by day 15 Radiotherapy in both arms
Outcomes	Visual analogue pain score (0 to 10) Toxicity (method not specified) Survival Ambulation and functional outcome (method not specified)
Notes	High‐dose versus low‐dose dexamethasone study terminated because of inadequate recruitment No significant difference in pain in the first week Analgesic use tended to be lower in high dose arm Pilot study, not powered for outcome, descriptive analysis Pain one of several endpoints
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Patients randomised via the Superdex website
Allocation concealment (selection bias)	Low risk	Website protected with password unique to each investigator
Blinding of participants and personnel (performance bias) All outcomes	High risk	Physicians were provided with patient's assigned treatment
Blinding of outcome assessment (detection bias) All outcomes	High risk	Physicians were provided with patient's assigned treatment
Incomplete outcome data (attrition bias) All outcomes	High risk	4 out of 20 patients not evaluable
Selective reporting (reporting bias)	Low risk	None detected
Other bias	High risk	Sample size: 20 participants (pilot study); < 50 participants per treatment arm