A systematic review of prognostic factors predicting survival in patients with spinal bone metastases

Bollen, Laurens; Jacobs, Wilco C. H.; Linden, Yvette M. van der; Hel, Olga van der; Taal, Walter; Dijkstra, P. D. Sander

doi:10.1007/s00586-017-5320-3

Cited by 33 publications

(20 citation statements)

References 40 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may not only be due to the patients’ oncologic outcome, but may also reflect the influence of other age-prevalent causes such as cardiovascular diseases. As reported by many studies before, we also found that the performance status was a strong prognostic factor for predicting the residual life expectancy after palliative RT of SBM in elderly patients [23–27]. Here, patients with a KPS below 70% had an extremely poor overall survival of less than 2 months compared to 9 months for those patients with a KPS of at least 70%.…”

Section: Discussionsupporting

confidence: 75%

Stability and survival analysis of elderly patients with osteolytic spinal bone metastases after palliative radiotherapy

et al. 2019

View full text Add to dashboard Cite

PurposeThis retrospective study aimed to evaluate the stability and fracture rates of osteolytic spinal bone metastases (SBM) in elderly patients following palliative radiotherapy (RT) and to derive prognostic factors for stability and survival.MethodsA total of 322 patients aged at least 70 years received palliative RT at two major German academic medical centers or at the German Cancer Research Center. Stability assessment was based on the validated Taneichi score prior to RT and at 3 and 6 months after RT. The survival time following RT was assessed, and prognostic factors for stability and survival were analyzed.ResultsPrior to RT, 183 patients (57%) exhibited unstable SBM and 68 patients (21%) pathological fractures. At 3 and 6 months after RT, significant recalcification and stabilization were evident in 19% (23/118) and 40% (31/78) of surviving patients, respectively. Only 17 patients (5%) experienced new pathological fractures following RT. Tumor histology was found to significantly influence stabilization rates with only breast cancer patients exhibiting increased stabilization compared to patients with other histologies. The median survival time and 6‑month survival rates following RT were 5.4 months (95% confidence interval 4.4–7.2 months) and 48%, respectively. The patients’ performance status was found to be the strongest predictor for survival after RT in this patient cohort; further factors demonstrating a significant association with survival were the application of systemic treatment, the number of SBM and the primary tumor histology. To analyze the influence of age on survival after RT, study patients were stratified into 3 age groups (i.e., 70–74 years, 75–79 years, and ≥80 years). The subgroup of patients aged at least 80 years showed a strong trend towards a worse survival time following RT compared to younger patients (i.e., 6‑month survival rate 39% vs. 51%; p = 0.06, log-rank test).ConclusionsPrognostic factors influencing overall survival such as performance status and histology should guide the choice for palliative RT for SBM. Strongly hypofractionated RT regimes may be advisable for most elderly patients considering the overall poor prognosis in order to reduce hospitalization times.

show abstract

Section: Discussionsupporting

confidence: 75%

Stability and survival analysis of elderly patients with osteolytic spinal bone metastases after palliative radiotherapy

et al. 2019

View full text Add to dashboard Cite

show abstract

“…It is crucial to identify factors that serve as prognosticators for increased survival, as only patients with a life expectancy of at least 3-6 months may experience the bone-mineralizing and stabilizing effects of palliative RT. Consistent with the findings of several other studies [28,36,[40][41][42], we identified the performance status as a strong prognostic factor for predicting OS after RT. As recalcification of irradiated osteolytic SBM usually takes up to several months, it is unlikely that patients with KPS < 70% would have a benefit with regard to stabilization within the remaining lifespan.…”

Section: Discussionsupporting

confidence: 91%

The Role of Palliative Radiotherapy in the Treatment of Spinal Bone Metastases from Head and Neck Tumors—A Multicenter Analysis of a Rare Event

Bostel

Rühle

Rackwitz

et al. 2020

Cancers

View full text Add to dashboard Cite

This retrospective multi-center analysis aimed to assess the clinical response and stabilizing effects of palliative radiotherapy (RT) for spinal bone metastases (SBM) in head and neck cancer (HNC), and to establish potential predictive factors for stability and overall survival (OS). Patients included in this analysis were treated at the University Hospitals of Mainz, Freiburg, and Heidelberg between 2001 and 2019. Clinical information was taken from the medical records. The stability of affected vertebral bodies was assessed according to the validated spine instability neoplastic score (SINS) based on CT-imaging before RT, as well as 3 and 6 months after RT. OS was quantified as the time between the start of palliative RT and death from any cause or last follow-up. Potential predictive factors for stability and OS were analyzed using generalized estimating equations and Cox regression for time-varying covariates to take into account multiple observations per patient. The mean follow-up time of 66 included patients after the first palliative RT was 8.1 months (range 0.3–85.0 months). The majority of patients (70%; n = 46) had squamous cell carcinomas (SCC) originating from the pharynx, larynx and oral cavity, while most of the remaining patients (26%; n = 17) suffered from salivary glands tumors. A total of 95 target volumes including 178 SBM were evaluated that received a total of 81 irradiation series. In patients with more than one metastasis per irradiated region, only the most critical bone metastasis was analyzed according to the SINS system. Prior to RT, pain and neurologic deficits were present in 76% (n = 72) and 22% (n = 21) of irradiated lesions, respectively, and 68% of the irradiated lesions (n = 65) were assessed as unstable or potentially unstable prior to RT. SBM-related pain symptoms and neurologic deficits responded to RT in 63% and 47% of the treated lesions, respectively. Among patients still alive at 3 and 6 months after RT with potentially unstable or unstable SBM, a shift to a better stability class according to the SINS was observed in 20% and 33% of the irradiated SBM, respectively. Pathological fractures of SBM were frequently detected before the start of irradiation (43%; n = 41), but after RT, new fractures or increasing vertebral body sintering within the irradiated region occurred rarely (8%; n = 8). A pathological fracture before RT was negatively associated with stabilization 6 months after RT (OR 0.1, 95% CI 0.02–0.49, p = 0.004), while a Karnofsky performance score (KPS) ≥ 70% was associated positively with a stabilization effect through irradiation (OR 6.09, 95% CI 1.68–22.05, p = 0.006). Mean OS following first palliative RT was 10.7 months, and the KPS (≥70% vs. <70%) was shown to be a strong predictive factor for OS after RT (HR 0.197, 95% CI 0.11–0.35, p < 0.001). There was no significant difference in OS between patients with SCC and non-SCC. Palliative RT in symptomatic SBM of HNC provides sufficient symptom relief in the majority of patients, while only about one third of initially unstable SBM show re-stabilization after RT. Since patients in our multi-center cohort exhibited very limited OS, fractionation schemes should be determined depending on the patients’ performance status.

show abstract

“…A recent systematic review. suggested that prognostication for patients with spinal metastases should be based on an accurate primary tumor classification, combined with a performance score, in which the added benefit of visceral metastases and other possible predictive factors should be studied further [19]. In our study brain and visceral metastases were significantly associated with survival, with an HR of 3.8 for brain metastases and HR of 1.34 for visceral metastases.…”

Section: Discussionmentioning

confidence: 53%

Prognostication of Patients with Spinal Bone Metastases (SBM): External Validation Study Comparing the Utility of Two Current Prediction Models

Sanli¹,

Terhaag²,

A³

et al. 2020

COR

View full text Add to dashboard Cite

Purpose: A majority of developed prediction models for SBM are not used in clinical practice, where there is lack of external validation studies describing their performance on independent patient data. Methods: Primary aim was to externally validate two prediction models and to demonstrate whether these can be generalized for patients treated in different centers. Secondary aim was to identify additional prognostic factors predicting survival in patients with SBM. Results: Our results show modest predictive capacity for patients with symptomatic SBM in daily clinical practice by use of the existing two prediction models Van der Linden and Bollen. A slightly better performance in discrimination and calibration is found for the Bollen model with a C-statistic of 0.67 (95% CI: 0.63 –0.71) based on the validation dataset (95% CI: 0.65 –0.73) in contrast to Van der Linden with a C-statistic of 0.65 (95% CI: 0.60–0.71). Impact of brain or visceral metastases was significantly associated with survival, with a Hazard Ratio (HR) of 3.8 and 1.34 respectively. For breast cancer patients with SBM, hormone receptor status was of importance for prognostication (C-statistic of 0.67). Conclusion: With this first external validation study, we found modest predictive capacity for the prediction models by van der Linden and Bollen, with a slightly better performance for the Bollen model. Predictive impact of overall visceral and brainmetastases should not be underestimated. Breast tumor subtypes based on immunohistochemistry markers, seem to be of importance for the prognostication of breast cancer patients with SBM.

show abstract

A systematic review of prognostic factors predicting survival in patients with spinal bone metastases

Cited by 33 publications

References 40 publications

Stability and survival analysis of elderly patients with osteolytic spinal bone metastases after palliative radiotherapy

Stability and survival analysis of elderly patients with osteolytic spinal bone metastases after palliative radiotherapy

The Role of Palliative Radiotherapy in the Treatment of Spinal Bone Metastases from Head and Neck Tumors—A Multicenter Analysis of a Rare Event

Prognostication of Patients with Spinal Bone Metastases (SBM): External Validation Study Comparing the Utility of Two Current Prediction Models

Contact Info

Product

Resources

About