Prognostic factors predicting functional outcomes, recurrence-free survival, and overall survival after radiotherapy for metastatic spinal cord compression in breast cancer patients.
OBJECTIVE
To identify significant prognostic factors after irradiation of metastatic spinal cord compression (MSCC) in 335 breast cancer patients.


METHODS
The potential prognostic factors investigated included involved vertebra, other bone metastases, visceral metastases, performance status, pretreatment ambulatory status, time until motor deficits developed before RT, radiation schedule (shorter-course RT [one fraction of 8 Gy/five fractions of 4 Gy] vs. longer-course RT [10 fractions of 3 Gy/15 fractions of 2.5 Gy/20 fractions of 2 Gy), and the response to RT.


RESULTS
On multivariate analysis, better functional outcome was associated with slower development of motor deficits (p <0.001) and being ambulatory before RT (p <0.001). The overall recurrence rate of MSCC was greater if other bone metastases were present (p <0.001) and if shorter-course RT was used (p <0.001). In-field recurrences alone were more frequent after shorter-course RT (p = 0.008). Survival was negatively affected by the presence of visceral metastases (p <0.001), deterioration of motor function after RT (p <0.001), reduced performance status (p <0.001), and the rapid development of motor deficits (p = 0.044).


CONCLUSIONS
Outcomes and survival after RT for MSCC in breast cancer patients are associated with several prognostic factors. Patients with poor expected survival may be treated with shorter-course RT to keep the overall treatment time short. If survival is expected to be relatively favorable, longer-course RT appears preferable, because it is associated with fewer MSCC recurrences.
Rades
Dirk
D
Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Rades.Dirk@gmx.net
Veninga
Theo
T
Stalpers
Lukas J A
LJ
Schulte
Rainer
R
Hoskin
Peter J
PJ
Poortmans
Philip
P
Schild
Steven E
SE
Rudat
Volker
V
D001943:Breast Neoplasms; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000209:etiology / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary