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A new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from breast cancer.

Rades D, Conde AJ, Garcia R, Cacicedo J, Segedin B, Perpar A, Schild SE - Radiat Oncol (2015)

Bottom Line: Factors significantly associated with survival in the Cox regression analysis were included in the prognostic instrument.Based on the patients' scores, three groups were designed: 18-27 points, 28-39 points and 40-42 points.Six-months survival rates were 4, 62 and 100%, respectively (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. rades.dirk@gmx.net.

ABSTRACT

Background: Elderly patients become more important in oncology. In this group, personalized treatment approaches taking into account survival prognoses and comorbidities play a major role. Predictive instruments are necessary to estimate the survival of elderly cancer patients. The importance of separate instruments for different tumor entities has been recognized. In this study, an instrument was generated to estimate the survival of elderly patients developing metastatic spinal cord compression (MSCC) from breast cancer.

Methods: In 218 elderly patients (age ≥65 years) irradiated for MSCC from breast cancer, nine factors were evaluated for survival: fractionation regimen, age, time from breast cancer diagnosis to RT of MSCC, visceral metastases, other bone metastases, time developing motor deficits, pre-radiotherapy ambulatory status, number of involved vertebrae, and Eastern Cooperative Oncology Group (ECOG) performance score. Factors significantly associated with survival in the Cox regression analysis were included in the prognostic instrument. Scores for each factor were calculated by dividing the 6-months survival rates by 10. The sums of these scores represented the patients' scores.

Results: On multivariate analyses, visceral metastases (p < 0.001), time developing motor deficits (p < 0.001), ambulatory status (p < 0.001), number of involved vertebrae (p = 0.032), and ECOG performance score (p < 0.001) were significant and included in the prognostic instrument. Based on the patients' scores, three groups were designed: 18-27 points, 28-39 points and 40-42 points. Six-months survival rates were 4, 62 and 100%, respectively (p < 0.001).

Conclusions: This new instrument contributes to personalized treatment in elderly patients with MSCC from breast cancer by predicting an individual patient's survival prognosis.

No MeSH data available.


Related in: MedlinePlus

Sum scores for each patient and the corresponding 6-months survival rates
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Fig1: Sum scores for each patient and the corresponding 6-months survival rates

Mentions: In the univariate analysis, survival was positively influenced by absence of visceral metastases (p < 0.001), absence of other bone metastases (p < 0.001), slower development of motor deficits before the start of RT (p < 0.001), ambulatory status before RT (p < 0.001), involvement of only 1–3 vertebrae (p < 0.001), and an ECOG performance score of 1–2 (p < 0.001). The results of the univariate analyses are summarized in Table 1. In the subsequent Cox regression analyses, visceral metastases (p < 0.001), time developing motor deficits before the start of RT (p < 0.001), ambulatory status before RT (p < 0.001), number of involved vertebrae (p = 0.032), and the ECOG performance score (p < 0.001) maintained significance (Table 2). These five factors were included in the prognostic instrument for prediction of survival (Table 3). The sum scores for the patients ranged between 18 and 42 points. The 6-months survival rates related to these points are presented in Fig. 1. Taking into account these survival rates, three survival groups were designed, 18–27 points (group A), 28–39 points (group B) and 40–42 points (group C). The 6-months survival rates of these three groups were 4, 62 and 100 %, respectively (p < 0.001, Fig. 2). The p-values for the comparisons of group A vs. group B and group B vs. group C were p < 0.001 and p = 0.003, respectively.Table 1


A new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from breast cancer.

Rades D, Conde AJ, Garcia R, Cacicedo J, Segedin B, Perpar A, Schild SE - Radiat Oncol (2015)

Sum scores for each patient and the corresponding 6-months survival rates
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4554297&req=5

Fig1: Sum scores for each patient and the corresponding 6-months survival rates
Mentions: In the univariate analysis, survival was positively influenced by absence of visceral metastases (p < 0.001), absence of other bone metastases (p < 0.001), slower development of motor deficits before the start of RT (p < 0.001), ambulatory status before RT (p < 0.001), involvement of only 1–3 vertebrae (p < 0.001), and an ECOG performance score of 1–2 (p < 0.001). The results of the univariate analyses are summarized in Table 1. In the subsequent Cox regression analyses, visceral metastases (p < 0.001), time developing motor deficits before the start of RT (p < 0.001), ambulatory status before RT (p < 0.001), number of involved vertebrae (p = 0.032), and the ECOG performance score (p < 0.001) maintained significance (Table 2). These five factors were included in the prognostic instrument for prediction of survival (Table 3). The sum scores for the patients ranged between 18 and 42 points. The 6-months survival rates related to these points are presented in Fig. 1. Taking into account these survival rates, three survival groups were designed, 18–27 points (group A), 28–39 points (group B) and 40–42 points (group C). The 6-months survival rates of these three groups were 4, 62 and 100 %, respectively (p < 0.001, Fig. 2). The p-values for the comparisons of group A vs. group B and group B vs. group C were p < 0.001 and p = 0.003, respectively.Table 1

Bottom Line: Factors significantly associated with survival in the Cox regression analysis were included in the prognostic instrument.Based on the patients' scores, three groups were designed: 18-27 points, 28-39 points and 40-42 points.Six-months survival rates were 4, 62 and 100%, respectively (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. rades.dirk@gmx.net.

ABSTRACT

Background: Elderly patients become more important in oncology. In this group, personalized treatment approaches taking into account survival prognoses and comorbidities play a major role. Predictive instruments are necessary to estimate the survival of elderly cancer patients. The importance of separate instruments for different tumor entities has been recognized. In this study, an instrument was generated to estimate the survival of elderly patients developing metastatic spinal cord compression (MSCC) from breast cancer.

Methods: In 218 elderly patients (age ≥65 years) irradiated for MSCC from breast cancer, nine factors were evaluated for survival: fractionation regimen, age, time from breast cancer diagnosis to RT of MSCC, visceral metastases, other bone metastases, time developing motor deficits, pre-radiotherapy ambulatory status, number of involved vertebrae, and Eastern Cooperative Oncology Group (ECOG) performance score. Factors significantly associated with survival in the Cox regression analysis were included in the prognostic instrument. Scores for each factor were calculated by dividing the 6-months survival rates by 10. The sums of these scores represented the patients' scores.

Results: On multivariate analyses, visceral metastases (p < 0.001), time developing motor deficits (p < 0.001), ambulatory status (p < 0.001), number of involved vertebrae (p = 0.032), and ECOG performance score (p < 0.001) were significant and included in the prognostic instrument. Based on the patients' scores, three groups were designed: 18-27 points, 28-39 points and 40-42 points. Six-months survival rates were 4, 62 and 100%, respectively (p < 0.001).

Conclusions: This new instrument contributes to personalized treatment in elderly patients with MSCC from breast cancer by predicting an individual patient's survival prognosis.

No MeSH data available.


Related in: MedlinePlus