title: A Prognostic Instrument to Estimate the Survival of Elderly Patients Irradiated for Metastatic Epidural Spinal Cord Compression From Lung Cancer.
abstract: BACKGROUND
  Elderly patients with lung cancer need personalized treatment in palliative situations such as metastatic epidural spinal cord compression (MESCC). It is crucial to know a patient's survival prognosis to be able to provide optimal and individualized care. Therefore, a prognostic instrument enabling physicians to estimate a patient's survival time is required. We created such an instrument in the present study.
  
  
  METHODS
  The data from 201 elderly patients with lung cancer irradiated for MESCC were retrospectively evaluated. The radiation regimen used plus 10 factors were analyzed for associations with survival, including age, gender, histologic features, performance status, interval from lung cancer diagnosis until irradiation of MESCC, interval to developing motor weakness before irradiation, number of affected vertebrae, visceral metastases, other bone metastases, and the ability to walk before irradiation. The factors significant on multivariate analysis were included in the predictive instrument. The factor scores were obtained by dividing the 6-month survival rate by 10, and the patient scores were determined from the sum of the factor scores.
  
  
  RESULTS
  Performance status (P = .003), interval to developing motor weakness (P = .006), visceral metastases (P < .001), and the ability to walk (P = .002) were associated with survival. Taking into account the 6-month survival rates of these factors, the patient scores ranged from 5 to 19 points. Thus, 4 groups were designated: those with 5 to 10 points (n = 95), 11 to 13 points (n = 46), 14 to 16 points (n = 33), and 18 to 19 points (n = 27). The corresponding 6-month survival rates were 4%, 26%, 58%, and 81% (P < .001). The corresponding median survival times were 2, 4, 7, and 10 months.
  
  
  CONCLUSIONS
  This new instrument will enable physicians to predict the survival prognosis of elderly patients with lung cancer-related MESCC, facilitating individualized treatment care.
authors.affiliation: Department of Radiation Oncology, University of Lubeck, Lubeck, Germany. Electronic address: rades.dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Conde-Moreno
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Segedin
authors.affiliation: Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya, Spain.
authors.forename: Jon
authors.initials: J
authors.lastname: Cacicedo
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy; D008297:Male; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D057285:Precision Medicine; D011379:Prognosis; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000401:mortality; D016019:Survival Analysis
keywords: Elderly patients; Lung cancer; Metastatic epidural spinal cord compression; Prognostic factors; Survival