Prognostic factors and a scoring system for survival after radiotherapy for metastases to the spinal column: a review of 544 patients at Shizuoka Cancer Center Hospital.
BACKGROUND
To optimize selection of a radiotherapy schedule for patients with spinal metastases, the authors analyzed prognostic factors and developed a scoring system to predict survival in such patients.


METHODS
Five-hundred forty-four patients with spinal metastases received radiotherapy at Shizuoka Cancer Center Hospital between September 2002 and November 2006. Prognostic factors for survival were studied using a Cox proportional hazards model, and a scoring system was developed based on regression coefficients: Three points were given for an unfavorable tumor type and bad performance status (> or =3); 2 points were given for hypercalcemia, visceral metastases, and previous chemotherapy; and 1 point was given for multiple bone metastases and age > or =71 years.


RESULTS
The overall survival rates after 6 months, 12 months, and 24 months were 49%, 32%, and 19%, respectively, and the median survival was 5.9 months (95% confidence interval, 4.9-6.8 months). In total, 503 patients (93%) were followed for > or =12 months or until death. These patients were separated into Groups A, B, and C based on scores of 0 to 4, 5 to 9, and 10 to 14, respectively. These groups included 24%, 57%, and 19% of patients, respectively; and the mean median survival for Groups A, B, and C was 27.1 months, 5.4 months, and 1.8 months, respectively. Overall survival rates after 6 months, 12 months, and 24 months were 89%, 77%, and 54% in Group A; 46%, 22%, and 9% in Group B; and 7%, 4%, and 0% in Group C, respectively (P < .001).


CONCLUSIONS
The scoring system was able to predict the survival of patients with spinal metastases and may be useful for selecting an optimal radiotherapy schedule.
Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, Japan. mizumoto1717@hotmail.com
Masashi
M
Mizumoto
Hideyuki
H
Harada
Hirofumi
H
Asakura
Takayuki
T
Hashimoto
Kazuhisa
K
Furutani
Haruko
H
Hashii
Tatsuya
T
Takagi
Hirohisa
H
Katagiri
Mitsuru
M
Takahashi
Tetsuo
T
Nishimura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D013125:Spinal Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary*