Prediction of survival in patients with metastases in the spinal column

Results based on a randomized trial of radiotherapy

Authors

  • Yvette M. van der Linden M.D.,

    Corresponding author
    1. Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
    2. Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands
    • Radiotherapeutic Institute Friesland, Borniastraat 36, 8934 AD Leeuwarden, The Netherlands
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    • Fax: (011) 31 582887570

  • Sander P. D. S. Dijkstra M.D., Ph.D.,

    1. Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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  • Ernest J. A. Vonk M.D.,

    1. Radiotherapy Institute Stedendriehoek and Omstreken, Deventer, The Netherlands
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  • Corrie A. M. Marijnen M.D., Ph.D.,

    1. Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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  • Jan Willem H. Leer M.D., Ph.D.,

    1. Department of Radiotherapy, St. Radboud University Medical Center, Nijmegen, The Netherlands
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  • for The Dutch Bone Metastasis Study Group


  • Performed on behalf of the Dutch Bone Metastasis Study Group. The Dutch Bone Metastasis Study Group consists of a steering committee (Jan Willem H. Leer, Yvette M. van der Linden, Hans van Houwelingen, Job Kievit, Wilbert B. van den Hout, Hanneke de Haes, and Elsbeth Steenland) and coordinators at participating institutions (Hendrik Martijn [Catharina Hospital, Eindhoven, The Netherlands], Bing Oei [Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands], Ernest Vonk [Radiotherapy Institute Stedendriehoek and Omstreken, Deventer, The Netherlands], Elzbieta M. van der Steen-Banasik [Arnhem Radiotherapy Institute, Arnhem, The Netherlands], Ruud G.J. Wiggenraad [Westeinde Hospital, Den Haag, The Netherlands], Jaap Hoogenhout [University Hospital Nijmegen, Nijmegen, The Netherlands], Carla C. Wárlám-Rodenhuis (University Medical Center, Utrecht, The Netherlands], Geertjan van Tienhoven [University Medical Center, Amsterdam, The Netherlands], Rinus Wanders [Limburg Radiotherapy Institute, Heerlen, The Netherlands], Jacqueline Pomp [Reinier de Graaf Hospital, Delft, The Netherlands], Matthijs van Reijn [Twente Medical Spectrum, Enschede, The Netherlands], Ineke van Mierlo [Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands], Ewald Rutten [Medical Center Alkmaar, Alkmaar, The Netherlands], Jan Metsaars [Leyenburg Hospital, Den Haag, The Netherlands], Gerrit Botke [Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands], and Ben G. Szabó [University Medical Center, Groningen, The Netherlands]).

Abstract

BACKGROUND

Adequate prediction of survival is important in deciding on treatment for patients with symptomatic spinal metastases. The authors reviewed 342 patients with painful spinal metastases without neurologic impairment who were treated conservatively within a large, prospectively randomized radiotherapy trial. Response to radiotherapy and prognostic factors for survival were studied.

METHODS

The data base of the Dutch Bone Metastasis Study was used. Response to treatment and prognostic factors for overall survival (OS) were studied using a Cox regression model. A scoring system was developed to predict OS.

RESULTS

Responses were noted in 73% of patients. In 3% of patients, spinal cord compression was reported a mean of 3.5 months after randomization. The median OS was 7 months, and significant predictors for survival were Karnofsky performance score, primary tumor (multivariate analysis; both P < 0.001), and the absence of visceral metastases (multivariate analysis; P = 0.02). A scoring system based on these predictors was developed, and 34% of patients were in Group A (median OS = 3.0 months), 48% of patients were in Group B (median OS = 9.0 months), and 18% of patients were in Group C (median OS = 18.7 months). Group C was comprised of patients with breast carcinoma, a good performance, and no visceral metastases.

CONCLUSIONS

Most patients with spinal metastases have a limited life expectancy and should be treated with caution regarding surgical procedures. Radiotherapy is a safe and effective, noninvasive treatment modality for pain. The new scoring system will enable physicians to select patients who may survive long enough to benefit from more radical treatment. Cancer 2005. © 2004 American Cancer Society.

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