A scoring system to predict local progression-free survival in patients irradiated with 20 Gy in 5 fractions for malignant spinal cord compression

Abstract

BackgroundLocal progression-free survival (LPFS = stable or improved motor function/resolution of paraplegia during RT without in-field recurrence following RT) is important when treating metastatic spinal cord compression (MSCC). An instrument to estimate LPFS was created to identify patients appropriately treated with short-course RT instead of longer-course RT plus/minus decompressive surgery.MethodsIn 686 patients treated with 20 Gy in 5 fractions alone, ten characteristics were retrospectively analyzed for LPFS including age, interval between tumor diagnosis and RT of MSCC, visceral metastases, other bone metastases, primary tumor type, gender, time developing motor deficits, pre-RT gait function, number of vertebrae affected by MSCC, and performance score. Characteristics significantly (p < 0.05) associated with LPFS on multivariate analyses were incorporated in the scoring system. Six-month LPFS rates for significant characteristics were divided by 10, and corresponding points were added.ResultsOn multivariate analyses, visceral metastases (p < 0.001), tumor type (p = 0.009), time developing motor deficits (p < 0.001) and performance score (p = 0.009) were associated with LPFS and used for the scoring system. Scores for patients ranged between 24 and 35 points. Three groups were designed: 24–28 (A), 29–31 (B) and 32–35 (C) points. Six-month LPFS rates were 46, 69 and 92%, 12-month LPFS rates 46, 63 and 83%. Median survival times were 2 months (61% died within 2 months), 4 months and ≥ 11 months (median not reached).ConclusionsMost group A patients appeared sub-optimally treated with 20 Gy in 5 fractions. Patients with survival prognoses ≤2 months may be considered for best supportive care or single-fraction RT, those with prognoses ≥3 months for longer-course RT plus/minus upfront decompressive surgery. Many group B and most group C patients achieved long-time LPFS and appeared sufficiently treated with 20 Gy in 5 fractions. However, based on previous data, long-term survivors may benefit from longer-course RT.

Predicting survival in anaplastic astrocytoma patients in a single-center cohort of 108 patients

“…The subscores of all significant parameters were totaled to result in the score for each patient. This methodological approach has been demonstrated in other studies [12,13].…”

Research on the predicting power of the revised Tokuhashi system: how much time can surgery give to patients with short life expectancy?

“…The above data are identical to what has been published in the literature. Rades et al [18] found a 2-, 4-and 11-months median OS time for their three subgroups of patients who underwent radiotherapy without surgery, da Silva et al [19] examined a population with secondary lesions caused by lung carcinoma, and described a median OS value between 8 and 12 months. Prognosis-predicting scoring systems establish the categorization of patients based on their survival time, which can help doctors choose the optimal type of treatment [20,21].…”