Prognostic factors and a scoring system for survival after radiotherapy for metastases to the spinal column

Abstract

BACKGROUND. To optimize selection of a radiotherapy schedule for patients with spinal metastases, the authors analyzed prognostic factors and developed a scoring system to predict survival in such patients. METHODS. Five‐hundred forty‐four patients with spinal metastases received radiotherapy at Shizuoka Cancer Center Hospital between September 2002 and November 2006. Prognostic factors for survival were studied using a Cox proportional hazards model, and a scoring system was developed based on regression coefficients: Three points were given for an unfavorable tumor type and bad performance status (≥3); 2 points were given for hypercalcemia, visceral metastases, and previous chemotherapy; and 1 point was given for multiple bone metastases and age ≥71 years. RESULTS. The overall survival rates after 6 months, 12 months, and 24 months were 49%, 32%, and 19%, respectively, and the median survival was 5.9 months (95% confidence interval, 4.9‐6.8 months). In total, 503 patients (93%) were followed for ≥12 months or until death. These patients were separated into Groups A, B, and C based on scores of 0 to 4, 5 to 9, and 10 to 14, respectively. These groups included 24%, 57%, and 19% of patients, respectively; and the mean median survival for Groups A, B, and C was 27.1 months, 5.4 months, and 1.8 months, respectively. Overall survival rates after 6 months, 12 months, and 24 months were 89%, 77%, and 54% in Group A; 46%, 22%, and 9% in Group B; and 7%, 4%, and 0% in Group C, respectively (P < .001). CONCLUSIONS. The scoring system was able to predict the survival of patients with spinal metastases and may be useful for selecting an optimal radiotherapy schedule. Cancer 2008. © 2008 American Cancer Society.

Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis

“…There is some controversy whether or not the increased cost and workload associated with SBRT is appropriate in the palliative setting of vertebral metastases [ 19 ]. Indeed, OS is short in unselected patients treated with conventional radiotherapy for painful vertebral metastases: Mizimoto et al reported a median OS of only 5.9 months in 544 patients [ 20 ] and van der Linden reported a median OS of 7 months in a cohort of 342 patients, who were randomized between a single fraction of 8 Gy and 6 × 4 Gy [ 21 ].…”

Clinical practice of image-guided spine radiosurgery - results from an international research consortium

“…Several prognostic scoring systems have been developed for overall survival after conventional, palliative radiotherapy for painful spine metastases [8,10,22] or metastatic spinal cord compression [23]. Recently, a recursive partitioning analysis (RPA) was reported for survival specific to spine SBRT [24].…”

“…This brief palliative effect may be sufficient for some patients with very short life expectancy. However, several predictive scores have been reported, which allow selection of patients with long life expectancy [8-10]. In particular, as modern chemotherapy may further prolong life expectancy, long-term palliation and long-term tumor control become even more important goals for patients despite having metastatic disease.…”

Reirradiation of spinal metastases with intensity-modulated radiation therapy: an analysis of 23 patients

“…Rades et al reported that the local control rates (LCRs) of metastatic spinal cord compression at 12 months were 61% after 8 Gy in 1 fraction or 20 Gy in 5 fractions and 81% after 30 Gy in 10 fractions, 37.5 Gy in 15 fractions, or 40 Gy in 20 fractions [ 6 ]. At our institution, the radiotherapy schedule for patients with bone metastases is selected by predicting prognosis on the basis of previously reported clinical results [ 7 – 10 ]. For most patients, the initially calculated dose of radiation to the bone metastasis is found to be adequate to relieve the pain, improve paresis, and prevent relapse; however, some patients experience in-field recurrence, and the necessity of reirradiation must be considered in these patients.…”