title: Prognostic factors in a series of 504 breast cancer patients with metastatic spinal cord compression.
abstract: BACKGROUND
  This study was performed to identify new significant prognostic factors in breast cancer patients irradiated for metastatic spinal cord compression (MSCC).
  
  
  METHODS
  The data of 504 patients with breast cancer patients with MSCC were retrospectively analyzed with respect to posttreatment motor function, local control of MSCC, and survival. The investigated potential prognostic factors included age, Eastern Cooperative Oncology Group (ECOG) performance score, number of involved vertebrae, other bone metastases, visceral metastases, pretreatment ambulatory status, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits before radiotherapy, and the radiation schedule.
  
  
  RESULTS
  On multivariate analysis, better functional outcome was associated with ambulatory status prior to RT (estimate - 1.29, p < 0.001), no visceral metastases (estimate - 0.52, p = 0.020), and slower development of motor deficits (estimate + 2.47, p < 0.001). Improved local control was significantly associated with no other bone metastases (risk ratio (RR) 4.33, 95% confidence interval (CI) 1.36-14.02, p = 0.013) and no visceral metastases (RR 3.02, 95% CI 1.42-6.40, p = 0.005). Improved survival was significantly associated with involvement of only 1-2 vertebrae (RR 1.27, 95% CI 1.01-1.60, p = 0.044), ambulatory status before radiotherapy (RR 1.75, 95% CI 1.23-2.50, p = 0.002), no other bone metastases (RR 1.93, 95% CI 1.18-3.13, p = 0.009), no visceral metastases (RR 7.60, 95% CI 5.39-10.84, p < 0.001), and time developing motor deficits before radiotherapy (RR 1.55, 95% CI 1.30-1.86, p < 0.001).
  
  
  CONCLUSIONS
  Several new independent prognostic factors were identified for treatment outcomes. These prognostic factors should be considered in future trials and may be used to develop prognostic scores for breast cancer patients with MSCC.
authors.affiliation: Department of Radiation Oncology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lubeck, Germany. rades.dirk@gmx.net
authors.forename: D
authors.initials: D
authors.lastname: Rades
authors.forename: S
authors.initials: S
authors.lastname: Douglas
authors.forename: T
authors.initials: T
authors.lastname: Veninga
authors.forename: L J A
authors.initials: LJ
authors.lastname: Stalpers
authors.forename: A
authors.initials: A
authors.lastname: Bajrovic
authors.forename: V
authors.initials: V
authors.lastname: Rudat
authors.forename: S E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000532:radiotherapy*; D015331:Cohort Studies; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008159:Lumbar Vertebrae / Q000528:radiation effects; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009460:Neurologic Examination / Q000528:radiation effects; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D016019:Survival Analysis; D013904:Thoracic Vertebrae / Q000528:radiation effects; D014057:Tomography, X-Ray Computed
chemical_list: D000932:Antiemetics; D003907:Dexamethasone