A validated score estimating ambulatory status following radiotherapy of elderly patients for metastatic spinal cord compression

Dirk Rades, Jasmin N. Evers, Volker Rudat, Amira Bajrovic, Johann H. Karstens, Steven E. Schild

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: This study was performed to develop a validated score predicting ambulatory status after radiotherapy (RT) alone for metastatic spinal cord compression (MSCC) in elderly patients.Methods: 1,129 elderly patients (≥65 years) were assigned to the test (N = 565) or validation group (N = 564). In the test group, nine pre-treatment factors (age, gender, tumor type, number of involved vertebrae, pre-RT ambulatory status, other bone metastases, visceral metastases, interval cancer diagnosis to RT, time developing motor deficits) and fractionation regimen were investigated. Factors significantly associated with post-RT ambulatory status on multivariate analysis were included in the score. The score for each factor was determined by dividing the post-RT ambulatory rate at 1 month (%) by 10. The total score represented the sum of these scores.Results: In the multivariate analysis of the test group, age, primary tumor type, pre-RT ambulatory status, visceral metastases, and time developing motor deficits were significantly associated with post-RT ambulatory status. Total scores were 19 to 41 points. In the test group, post-RT ambulatory rates were 5% for 19-25 points, 35% for 26-30 points, 80% for 31-34 points, and 98% for 35-41 points (p < 0.001). 6-month survival rates were 11%, 21%, 59% and 76%, respectively. In the validation group, post-RT ambulatory rates were 4%, 33%, 77% and 98%, respectively (p < 0.001).Conclusions: Patients achieving 19-25 points had very poor functional outcomes and survival, and may receive single-fraction RT for pain relief. Selected patients with 26-34 points may benefit from additional surgery. Patients achieving ≥35 points achieved favorable results after RT alone.

Original languageEnglish (US)
Article number589
JournalBMC cancer
Volume14
Issue number1
DOIs
StatePublished - Aug 14 2014

Keywords

  • Ambulatory status
  • Elderly patients
  • MSCC
  • Prognostic factors
  • Score

ASJC Scopus subject areas

  • Genetics
  • Oncology
  • Cancer Research

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