title: Overall survival after reirradiation of spinal metastases - independent validation of predictive models.
abstract: BACKGROUND
  It is unknown if survival prediction tools (SPTs) sufficiently predict survival in patients who undergo palliative reirradiation of spinal metastases. We therefore set out to clarify if SPTs can predict survival in this patient population.
  
  
  METHODS
  We retrospectively analyzed spinal reirradiations performed (n = 58, 52 patients, 44 included in analysis). SPTs for patients with spinal metastases were identified and compared to a general palliative score and to a dedicated SPT to estimate prognosis in palliative reirradiation independent of site (SPT-Nieder).
  
  
  RESULTS
  Consistently in all tests, SPT-Nieder showed best predictive performance as compared to other tools. Items associated with survival were general condition (KPS), liver metastases, and steroid use. Other factors like primary tumor site, pleural effusion, and bone metastases were not correlated with survival. We adapted an own score to the data which performed comparable to SPT-Nieder but avoids the pleural effusion item. Both scores showed good performance in identifying long-term survivors with late recurrences.
  
  
  CONCLUSIONS
  Survival prediction in case of spinal reirradiation is possible with sufficient predictive separation. Applying SPTs in case of reirradiation helps to identify patients with good life expectancy who might benefit from dose escalation or longer treatment courses.
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. daniel_buergy@medma.uni-heidelberg.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Buergy
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. lena.siedlitzki@gmail.com.
authors.forename: Lena
authors.initials: L
authors.lastname: Siedlitzki
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. judit.boda-heggemann@umm.de.
authors.forename: Judit
authors.initials: J
authors.lastname: Boda-Heggemann
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. frederik.wenz@umm.de.
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. lohr.frank@policlinico.mo.it.
authors.forename: Frank
authors.initials: F
authors.lastname: Lohr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003198:Computer Simulation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D010996:Pleural Effusion; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018787:Radiation Oncology / Q000379:methods / Q000592:standards; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D000069475:Re-Irradiation / Q000379:methods; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000532:radiotherapy*; D016896:Treatment Outcome