A New and Easy-to-Use Survival Score for Patients Irradiated for Metastatic Epidural Spinal Cord Compression

Rades, Dirk; Cacicedo, Jon; Lomidze, Darejan; Al-Salool, Ahmed; Šegedin, Barbara; Grošelj, Blaž; Jankarashvili, Natalia; Conde-Moreno, Antonio J.; Schild, Steven E.

doi:10.1016/j.prro.2022.03.012

Cited by 5 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For the RAMSES-01 trial, 52 of the 65 planned patients were recruited between 08/2019 and 11/2021. Since during this study OS was found to be worse than expected, a new survival score was developed, which was more precise in predicting OS than the tool used for the RAMSES-01 trial [ 18 ]. As a consequence, the RAMSES-01 trial was terminated.…”

Section: Resultsmentioning

confidence: 99%

“…This finding may be explained by the fact that since the Patchell trial was published, many patients with longer estimated survival times receive upfront surgery, and those assigned to radiotherapy alone have comparably less favorable prognoses [ 2 ]. Therefore, we decided to develop a new survival score based on the data of patients treated with radiotherapy alone within prospective trials [ 18 ]. The new scoring tool was based on three prognostic factors, namely, the type of primary tumor, pre-radiotherapy ambulatory status, and visceral metastases.…”

Section: Discussionmentioning

confidence: 99%

“…The new scoring tool was based on three prognostic factors, namely, the type of primary tumor, pre-radiotherapy ambulatory status, and visceral metastases. It was more accurate in identifying patients who live 6 months or longer when compared to the previous score [ 11 , 18 ]. Corresponding positive predictive values were 90% and 64%, respectively.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Radiotherapy for Metastatic Epidural Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial

Rades,

Lomidze,

Jankarashvili

et al. 2024

Cancers

Self Cite

View full text Add to dashboard Cite

Patients with metastatic epidural spinal cord compression (MESCC) and favorable survival prognoses may benefit from radiation doses exceeding 10 × 3.0 Gy. In a multi-center phase 2 trial, patients receiving 15 × 2.633 Gy (41.6 Gy10) or 18 × 2.333 Gy (43.2 Gy10) were evaluated for local progression-free survival (LPFS), motor/sensory functions, ambulatory status, pain, distress, toxicity, and overall survival (OS). They were compared (propensity score-adjusted Cox regression) to a historical control group (n = 266) receiving 10 × 3.0 Gy (32.5 Gy10). In the phase 2 cohort, 50 (of 62 planned) patients were evaluated for LPFS. Twelve-month rates of LPFS and OS were 96.8% and 69.9%, respectively. Motor and sensory functions improved in 56% and 57.1% of patients, and 94.0% were ambulatory following radiotherapy. Pain and distress decreased in 84.4% and 78.0% of patients. Ten and two patients experienced grade 2 and 3 toxicities, respectively. Phase 2 patients showed significantly better LPFS than the control group (p = 0.039) and a trend for improved motor function (p = 0.057). Ambulatory and OS rates were not significantly different. Radiotherapy with 15 × 2.633 Gy or 18 × 2.333 Gy was well tolerated and appeared superior to 10 × 3.0 Gy.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiotherapy for Metastatic Epidural Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial

Rades,

Lomidze,

Jankarashvili

et al. 2024

Cancers

Self Cite

View full text Add to dashboard Cite

show abstract

“…Goals of treatment (pain relief, tumor growth inhibition, prolongation of survival) vary and are influenced by several patient-and disease-related factors, e.g., patient preference, performance status (PS), overall tumor burden, availability and efficacy of systemic anticancer treatment, and size of the radiation target volume [3][4][5]. The recent scientific focus on radiotherapy personalization holds promise with regard to prescription of patient-specific fractionation regimens [6,7]. The primary aim of many publications was to analyze death within 30 days and to provide predictive K tools that may assist clinicians who wish to avoid prolonged fractionation regimens in the final phase of cancer progression [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

et al. 2023

View full text Add to dashboard Cite

Background Recently, the palliative appropriateness criteria (PAC) score, a novel metric to aid clinical decision-making between different palliative radiotherapy fractionation regimens, has been developed. It includes baseline parameters including but not limited to performance status. The researchers behind the PAC score analyzed the percent of remaining life (PRL) on treatment. The latter was accomplished by calculating the time between start and finish of palliative radiotherapy (minimum 1 day in case of a single-fraction regimen) and dividing it by overall survival in days from start of radiotherapy. The purpose of the present study was to validate this novel metric. Patients and methods The retrospective validation study included 219 patients (287 courses of palliative radiotherapy). The methods were identical to those employed in the score development study. The score was calculated by assigning 1 point each to several factors identified in the original study and using the online calculator provided by the PAC developers. Results Median survival was 6 months and death within 30 days from start of radiotherapy was recorded in 13% of courses. PRL on treatment ranged from 1 to 23%, median 8%. Significant associations were confirmed between online-calculated PAC score, observed survival, and risk of death within 30 days from the start of radiotherapy. Patients with score 0 had distinctly better survival than all other groups. The score-predicted median risk of death within 30 days from start of radiotherapy was 22% in our cohort. A statistically significant correlation was found between predicted and observed risk (p < 0.001). The original and present study were not perfectly concordant regarding number and type of baseline parameters that should be included when calculating the PAC score. Conclusion This study supports the dual strategy of PRL and risk of early death calculation, with results stratified for fractionation regimen, in line with the original PAC score study. When considering multifraction regimens, the PAC score identifies patients who may benefit from shorter courses. Additional work is needed to answer open questions surrounding the underlying components of the score, because the original and validation study were only partially aligned.

show abstract

“…In order to support decision-making for elderly patients with bone metastases managed with palliative radiotherapy, Rades et al have recently developed and validated a dedicated survival prediction model (13). They excluded the special setting of metastatic spinal cord compression resulting from bone metastases, because previous research already has resulted in diagnosis-specific models (14,15). Their study included 348 patients who were ≥65 years of age and had received palliative radiotherapy in the time period 2009-2021, often 10 fractions of 3 Gy (47%).…”

mentioning

confidence: 99%

Independent Validation of a Risk Stratification Model Predicting Survival in Elderly Patients Irradiated for Bone Metastases

et al. 2023

View full text Add to dashboard Cite

Background/Aim: The aim of this study was to analyze the validity of a prognostic model, originally developed by Rades et al., because international variations in clinical practice and survival outcomes may impact on the performance of predictive tools. Materials and Methods: Retrospectively, data from a single institution were analyzed. The study included 305 patients managed with palliative radiotherapy for bone metastases. The Rades et al. score was assigned and the resulting 3 prognostic strata compared. Results: The median overall survival for the 3 strata was 48, 248 and 1065 days, respectively (p<0.001). However, the original break-down (17 points versus 18-25 points versus >25 points) was not in accordance with the overlapping survival curves in some of the subgroups, leading us to propose slight adjustments. The modified model also performed satisfactorily in the oldest patients (age ≥80 years; median survival 26, 192 and 489 days, respectively, p<0.001). Conclusion: The original Rades et al. score is a valid prognostic model in our Norwegian validation database. However, modification is suggested, in particular inclusion of patients with 18 points into the poor prognosis group..

show abstract

A New and Easy-to-Use Survival Score for Patients Irradiated for Metastatic Epidural Spinal Cord Compression

Cited by 5 publications

References 29 publications

Radiotherapy for Metastatic Epidural Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial

Radiotherapy for Metastatic Epidural Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial

Palliative appropriateness criteria: external validation of a new method to evaluate the suitability of palliative radiotherapy fractionation

Independent Validation of a Risk Stratification Model Predicting Survival in Elderly Patients Irradiated for Bone Metastases

Contact Info

Product

Resources

About