title: Prognostic factors predicting functional outcomes, recurrence-free survival, and overall survival after radiotherapy for metastatic spinal cord compression in breast cancer patients.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Rades.Dirk@gmx.net
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
authors.forename: Rainer
authors.initials: R
authors.lastname: Schulte
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
mesh_terms: 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