Survival and prognostic factors in non-small cell lung cancer patients with spinal bone metastases: a retrospective analysis of 303 patients.
OBJECTIVE
For palliative care of spinal bone metastases, stability assessment is of crucial importance. Pathological fractures, instability-related patient immobility and the extent of bone metastasis have been reported to affect patient outcome and these parameters have therefore been used for treatment stratification. We report on stability-dependent fracture and survival rates in over 300 non-small cell lung cancer (NSCLC) patients.


METHODS
Data from 303 patients with 868 osteolytic metastases treated with radiotherapy (RT) between 2000 and 2012 were evaluated retrospectively.


RESULTS
In NSCLC patients with bone metastases only, the retrospective 6- and 12-month overall survival (OS) rates were 76.7 and 47.2%, respectively. In patients with additional non-bone distant metastases, these values were 60.0 and 34.0%, respectively. Survival rates were significantly lower in patients with multiple bone metastases and in those suffering pathological fractures (p=0.017). No significant impact of histological type, location of spinal lesions or treatment regime was detected. Furthermore, stability assessment revealed no influence of vertebral column stability on patient outcome (p=0.739).


CONCLUSIONS
Our analysis demonstrated a correlation between the pathological fractures of bone lesions, the number of bone metastases, additional distant metastases and survival. The results offer a rationale for future prospective investigations.
Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany, Harald.Rief@med.uni-heidelberg.de.
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H
Rief
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T
Muley
T
T
Bruckner
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T
Welzel
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Rieken
M
M
Bischof
K
K
Lindel
S E
SE
Combs
J
J
Debus
D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D011379:Prognosis; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000401:mortality* / Q000517:prevention & control; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D015996:Survival Rate