S. Douglas

Validation and simplification of a score predicting survival in patients irradiated for metastatic spinal cord compression

Based on an analysis of 1852 retrospectively evaluated patients with metastatic spinal cord compression (MSCC), a scoring system was developed to predict survival. This study was performed to validate the scoring system in a new data set.

A validated survival score for patients with metastatic spinal cord compression from non-small cell lung cancer

BackgroundThis multicenter study aimed to create and validate a scoring system for survival of patients with metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC).MethodsThe entire cohort of 356 patients was divided in a test group (N = 178) and a validation group (N = 178). In the test group, nine pre-treatment factors including age, gender, Eastern Cooperative Oncology Group performance status (ECOG-PS), number of involved vertebrae, pre-radiotherapy ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, and the time developing motor were retrospectively analyzed.ResultsOn multivariate analysis, survival was significantly associated with ECOG-PS, pre-radiotherapy ambulatory status, visceral metastases, and the time developing motor deficits. These factors were included in the scoring system; the score for each factor was determined by dividing the 6-month survival rate (in %) by 10. The risk score represented the sum of the scores for each factor. According to the risk scores, which ranged from 6 to 19 points, three prognostic groups were designed. The 6-month survival rates were 6% for 6–10 points, 29% for 11–15 points, and 78% for 16–19 points (p < 0.001). In the validation group, the 6-month survival rates were 4%, 24%, and 76%, respectively (p < 0.001).ConclusionsSince the survival rates of the validation group were similar to those of the test group, this score can be considered reproducible. The scoring system can help when selecting the individual treatment for patients with MSCC from NSCLC. A prospective confirmatory study is warranted.

Validation of a Score Predicting Post-Treatment Ambulatory Status After Radiotherapy for Metastatic Spinal Cord Compression

PURPOSE A score predicting post-radiotherapy (RT) ambulatory status was developed based on 2,096 retrospectively evaluated metastatic spinal cord compression (MSCC) patients. This study aimed to validate the score in a prospective series. METHODS AND MATERIALS The score included five factors associated with post-RT ambulatory status: tumor type, interval tumor diagnosis to MSCC, visceral metastases, pre-RT motor function, time developing motor deficits. Patients were divided into five groups: 21-28, 29-31, 32-34, 35-37, 38-44 points. In this study, 653 prospectively followed patients were divided into the same groups. Furthermore, the number of prognostic groups was reduced from five to three (21-28, 29-37, 38-44 points). Post-RT ambulatory rates from this series were compared with the retrospective series. Additionally, this series was compared with 104 patients receiving decompressive surgery plus RT (41 laminectomy, 63 laminectomy plus stabilization of vertebrae). RESULTS In this study, post-RT ambulatory rates were 10.6% (21-28 points), 43.5% (29-31 points), 71.0% (32-34 points), 89.5% (35-37 points), and 98.5% (38-44 points). Ambulatory rates from the retrospective study were 6.2%, 43.5%, 70.0%, 86.1%, and 98.7%. After regrouping, ambulatory rates were 10.6% (21-28 points), 70.9% (29-37 points), and 98.5% (38-44 points) in this series, and 6.2%, 68.4%, and 98.7% in the retrospective series. Ambulatory rates were 0%, 62.5%, and 90.9% in the laminectomy plus RT group, and 14.3%, 83.9%, and 100% in the laminectomy + stabilization plus RT group. CONCLUSIONS Ambulatory rates in the different groups in this study were similar to those in the retrospective study demonstrating the validity of the score. Using only three groups is simpler for clinical routine.

A validated survival score for breast cancer patients with metastatic spinal cord compression

BackgroundTo create a validated scoring system predicting survival of breast cancer patients with metastatic spinal cord compression (MSCC).Patients and methodsOf 510 patients, one half were assigned to either the test or the validation group. In the test group, eight pretreatment factors (age, performance status, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time of developing motor deficits) plus the radiation regimen were retrospectively investigated. Factors significantly associated with survival in the multivariate analysis were included in the scoring system. The score for each factor was determined by dividing the 6-month survival rate (%) by ten. The total score was the sum of the scores for each factor.ResultsIn the multivariate analysis of the test group, performance status, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, and time of developing motor deficits were significant for survival and included in the score. Total scores ranged from 30 to 50 points. In the test group, the 6-month survival rates were 12% for 30–35 points, 41% for 36–40 points, 74% for 41–45 points, and 98% for 46–50 points (p < 0.0001). In the validation group, the 6-month survival rates were 14%, 46%, 77%, and 99%, respectively (p < 0.0001).ConclusionThe survival rates of the validation group were similar to the test group. Therefore, this score was reproducible and can help when selecting the appropriate radiotherapy regimen for each patient taking into account her survival prognosis.ZusammenfassungHintergrundZiel dieser Arbeit war es, einen validierten Score zu entwickeln, mit dem das Überleben von Brustkrebspatientinnen mit metastatisch bedingter Rückenmarkskompression („metastatic spinal cord compression“, MSCC) vorausgesagt werden kann.Patienten und MethodeVon insgesamt 510 Patientinnen wurde jeweils die Hälfte der Testgruppe oder der Validierungsgruppe zugeteilt. In der Testgruppe wurden acht prätherapeutische Faktoren (Alter, Allgemeinzustand, Zahl befallener Wirbelkörper, Gehfähigkeit, andere Knochenmetastasen, Organmetastasen, Intervall von der Erstdiagnose der Tumorerkrankung bis zur Strahlentherapie der MSCC, Entwicklungszeit motorischer Defizite) und das Fraktionierungsschema retrospektiv untersucht. Die Faktoren, die in der Multivarianzanalyse signifikant mit dem Überleben assoziiert waren, gingen in den Score ein. Der Score für jeden Faktor wurde ermittelt, indem die 6-Monats-Überlebensrate (%) durch zehn geteilt wurde. Der Prognosescore entsprach der Summe der Scores der einzelnen Faktoren.ErgebnisseIn der multivariaten Analyse der Testgruppe waren der Allgemeinzustand, Gehfähigkeit, andere Knochenmetastasen, Organmetastasen, das Intervall von der Erstdiagnose der Tumorerkrankung bis zur Strahlentherapie der MSCC und die Entwicklungszeit motorischer Defizite signifikant mit dem Überleben assoziiert. Die Scores lagen zwischen 30 und 50 Punkten. In der Testgruppe betrugen die 6-Monats-Überlebensraten 12% bei 30–35 Punkten, 41% bei 36–40 Punkten, 74% bei 41–45 Punkten und 98% bei 46–50 Punkten (p < 0,0001). In der Validierungsgruppe betrugen die entsprechenden 6-Monats-Überlebensraten 14%, 46%, 77%, und 99% (p < 0,0001).SchlussfolgerungenDie Überlebensraten in der Validierungsgruppe ähnelten den Überlebensraten in der Testgruppe. Demzufolge kann der Score als reproduzierbar angesehen werden. Der Score kann dabei helfen, das am besten geeignete Bestrahlungsregime für die einzelne Patientin unter Berücksichtigung ihrer Überlebensprognose auszuwählen.

A new score predicting the survival of patients with spinal cord compression from myeloma

BackgroundThis study was performed to create and validate a scoring system for the survival of patients with malignant spinal cord compression (SCC) from myeloma.MethodsOf the entire cohort (N = 216), 108 patients were assigned to a test group and 108 patients to a validation group. In the test group, nine pre-treatment factors including age, gender, Eastern Cooperative Oncology Group performance status (ECOG-PS), number of involved vertebrae, ambulatory status prior to radiotherapy, other bone lesions, extraosseous lesions, interval from first diagnosis of myeloma to radiotherapy of SCC, and the time developing motor deficits were retrospectively analyzed.ResultsOn univariate analysis, improved survival was associated with ECOG-PS 1–2 (p = 0.006), being ambulatory (p = 0.005), and absence of other bone lesions (p = 0.019). On multivariate analysis, ECOG-PS (p = 0.036) and ambulatory status (p = 0.037) were significant; other bone lesions showed a strong trend (p = 0.06). These factors were included in the score. The score for each factor was determined by dividing the 12-month survival rate (in%) by 10. The total risk score was the sum of the three factor scores and ranged from 19 to 24 points. Three prognostic groups were designed with the following 12-month survival rates: 49% for 19–20 points, 74% for 21–23 points, and 93% for 24 points (p = 0.002). In the validation group, the 12-month survival rates were 51%, 80%, and 90%, respectively (p < 0.001).ConclusionsThis score appears reproducible, because the 12-month survival rates of both the test and the validation group were very similar. This new survival score can help personalize the treatment of patients with SCC from myeloma and can be of benefit when counseling patients.

Prognostic factors for different outcomes in patients with metastatic spinal cord compression from cancer of unknown primary

BackgroundPatients with cancer of unknown primary account for 10% of patients with metastatic spinal cord compression (MSCC). This retrospective study was performed to identify prognostic factors for functional outcome, local control of MSCC, and survival in 175 of such patients treated with radiotherapy alone.MethodsInvestigated were nine potential prognostic factors including age, gender, Eastern Cooperative Oncology Group performance score (ECOG-PS), number of involved vertebrae, pre-radiotherapy ambulatory status, other bone metastases, visceral metastases, time developing motor deficits before radiotherapy, and the radiation schedule.ResultsOn multivariate analysis, better functional outcome was associated with absence of visceral metastases (estimate: 0.72; 95%-confidence interval [CI]: 0.07-1.36; p = 0.030) and a slower (>7 days) development of motor deficits (estimate: 1.93; 95%-CI: 1.18-2.68; p < 0.001). Improved local control of MSCC was associated with absence of visceral metastases (risk ratio [RR]: 10.26; 95%-CI: 2.11-74.73; p = 0.004). Improved survival was associated with favorable ECOG-PS (RR: 2.12; 95%-CI: 1.40-3.29; p < 0.001), being ambulatory prior to radiotherapy (RR: 1.98; 95%-CI: 1.40-2.81; p < 0.001), absence of visceral metastases (RR: 2.74; 95%-CI: 1.93-3.91; p < 0.001), and slower development of motor deficits (RR: 1.27; 95%-CI: 1.07-1.51; p = 0.007). Absence of other bone metastases showed a trend (RR: 1.38; 95%-CI: 0.98-1.95; p = 0.07).ConclusionsThis study identified additional independent prognostic factors for functional outcome, local control of MSCC, and survival after radiotherapy of MSCC from cancer of unknown primary. These prognostic factors can help select the best treatment regimen for each individual patient.