title: Stability, prognostic factors and survival of spinal bone metastases in malignant melanoma patients after palliative radiotherapy.
abstract: OBJECTIVE
  This retrospective analysis aimed to evaluate the stability of spinal metastases in malignant melanoma patients following radiotherapy (RT), and to assess prognostic factors for survival.
  
  
  METHODS
  Forty-one patients with malignant melanoma and osteolytic spinal bone metastases were irradiated at the university clinics of Heidelberg and Mainz between July 2003 and October 2013. Three and six months after palliative RT, only 20 and 15 patients, respectively, were still alive and were therefore assessed for spinal stability using the Taneichi score based on CT imaging. Additionally, overall survival (OS) and bone survival (BS) rates as well as prognostic factors for BS were evaluated for all study patients.
  
  
  RESULTS
  Before RT, 19 patients (46.3%) were rated unstable. In the surviving patients, none of the unstable metastases were classified as stable 6 months after RT. Five-year OS was 23.3% and median BS was 4 months (range 0.5-29.8). Accordingly, only 36.6% of the patients were still alive 6 months after RT. Karnofsky performance score (KPS) &lt;70%, visceral metastases and more than one bone metastasis were significantly predictive of poor BS.
  
  
  CONCLUSIONS
  Our study population was characterized by poor BS and a lack of benefit with regard to stabilization of initially unstable spinal bone metastases 3 and 6 months after RT. This applies in particular to patients with a KPS &lt;70%, visceral metastases and multiple bone metastases. Given the limited life expectancy, short fractionated treatment schedules of RT may be preferred in this population.
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Bostel
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Förster
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schlampp
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Wolf
authors.affiliation: Department of Radiation Oncology, University Hospital Mainz, Mainz - Germany.
authors.forename: Andre Franke
authors.initials: AF
authors.lastname: Serras
authors.affiliation: Department of Radiation Oncology, University Hospital Mainz, Mainz - Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Mayer
authors.affiliation: Department of Medical Biometry, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Welzel
authors.affiliation: Department of Radiation Oncology, University Hospital Mainz, Mainz - Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Schmidberger
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg - Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Rief
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D001915:Braces; D004164:Diphosphonates / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology*; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000150:complications / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology*; D013125:Spinal Neoplasms / Q000150:complications / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D013904:Thoracic Vertebrae / Q000473:pathology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates