A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression
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· T. Veninga2 · A. Bajrovic3 · J.H. Karstens4 · S.E. Schild5 1 Department of Radiation Oncology, University of Lubeck 2 Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg 3 Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf 4 Department of Radiation Oncology, Hannover Medical University, Hannover 5 Department of Radiation Oncology, Mayo Clinic Scottsdale, Arizona
A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression The majority of patients with metastatic spinal cord compression (MSCC) only live for a few months [2, 11]. However, a considerable proportion of patients with MSCC have a much more favorable survival prognosis. It is not clear whether such long-term survivors are sufficiently treated with radiotherapy (RT) alone, or whether they would benefit from more aggressive treatments such as decompressive surgery or high-precision RT (image-guided intensity-modulated radiotherapy, IG-IMRT; fractionated stereotactic body radiotherapy, SBRT and single-fraction radiosurgery). Recently published evidence-based guidelines were quite reserved regarding these specialized RT techniques for MSCC, since the rationale for such methods is based primarily on single-institution retrospective analyses [6]. Furthermore, such treatments can be very time consuming. A randomized study begun in 2003 demonstrated a benefit of upfront decompressive surgery in addition to RT for highly selected patients. This group included patients with a good performance status, a favorable survival prognosis and involvement of only one spinal segment. Today, many patients meeting these criteria receive decompressive surgery in addition to RT (rather than RT alone) [9]. Surgery-related complications such as wound infections, extensive bleeding, postoperative pneumonia and pulmonary embolism occur in 11–13% of patients [9, 13, 14].
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Strahlentherapie und Onkologie 6 · 2013
It has been reported that selected longterm MSCC survivors—such as patients with oligometastatic disease—can experience favorable results with conventional RT alone. Surgery-related complications and the inconvenience of long, high-precision RT treatments can thus be avoided. Up until now, it has been a challenge for the treating physicians to identify these long-term survivors following RT alone. The present study aimed to develop a scoring system to identify long-term survivors after conventional RT alone with high specificity and a high positive predictive value.
in order to avoid a potential selection bias [12]. Of 1,359 patients receiving longcourse RT comprising either 10 fractions of 3 Gy in 2 weeks, 15 fractions of 2.5 Gy in 3 weeks or 20 fractions of 2 Gy in 4 weeks between 1992 and 2011, 344 patients survived for more than 1 year after RT, 781 patients died within 1 year, and 234 patients were still alive at their last follow-up visit, which took place ≤1 year after RT. The following pretreatment characteristics were evaluated: age (≤60 vs. >60 years)
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