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

• Published in: Cancer 2008-11, Vol.113 (10), p.2816-2822
• Main Authors: Mizumoto, Masashi, Harada, Hideyuki, Asakura, Hirofumi, Hashimoto, Takayuki, Furutani, Kazuhisa, Hashii, Haruko, Takagi, Tatsuya, Katagiri, Hirohisa, Takahashi, Mitsuru, Nishimura, Tetsuo
• Format: Article
• Language: eng ; jpn
• Subjects: bone metastases; prognostic factors; radiotherapy; scoring system; spinal metastases
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.23888

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. The authors analyzed prognostic factors and developed a scoring system to optimize the selection of a radiotherapy schedule for patients with spinal metastases and to predict their survival. The scoring system was capable of predicting the survival of patients with spinal metastases, and further prospective studies using this system will be needed to determine the optimal radiotherapy schedule appropriate for survival.