A score predicting posttreatment ambulatory status in patients irradiated for metastatic spinal cord compression.
OBJECTIVE
To create a scoring system to predict ambulatory status after radiotherapy (RT) for metastatic spinal cord compression (MSCC).


METHODS
On the basis of a multivariate analysis of 2096 MSCC patients, a scoring system was developed. This included the five prognostic factors significantly associated with post-RT ambulatory status: primary tumor type, interval between tumor diagnosis and MSCC, visceral metastases, motor function before RT, and time developing motor deficits before RT. The score for each factor was determined by dividing the post-RT ambulatory rate (as a percentage) by 10. Total scores represented the sum of the scores for each factor and ranged between 21 and 44 points. Patients were divided into five groups according to this score.


RESULTS
The post-RT ambulatory rates were 6% (24 of 389) for patients with scores of </=28 points, 44% (121 of 278) for those with 29-31 points, 70% (212 of 303) for those with 32-34 points, 86% (315 of 266) for those with 35-37 points, and 99% (750 of 760) for those with >/=38 points. The 3-month survival rates were 29%, 62%, 77%, 84%, and 98%, respectively. The 6-months survival rates were 6%, 31%, 42%, 61%, and 93%, respectively.


CONCLUSIONS
Because patients with scores of </=28 points had poor functional outcome after RT and extraordinarily poor survival rates, short-course RT to decrease pain or best supportive care may be considered. Patients with scores of 29-37 points should be considered surgical candidates, because RT-alone results were not optimal. Patients with scores of >/=38 points seem to have excellent results with RT alone.
Rades
Dirk
D
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany.
Rudat
Volker
V
Veninga
Theo
T
Stalpers
Lukas J A
LJ
Basic
Hiba
H
Karstens
Johann H
JH
Hoskin
Peter J
PJ
Schild
Steven E
SE
D000367:Age Factors; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000150:complications / Q000532:radiotherapy; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy* / Q000534:rehabilitation; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary; D013125:Spinal Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary; D016019:Survival Analysis; D017741:Survivors; D016138:Walking