A New Clinical Instrument for Estimating the Ambulatory Status after Irradiation for Malignant Spinal Cord Compression

Data de publicació: 07/08/2022 Data Ahead of Print: 07/08/2022

Autors de IIS La Fe

Antonio Conde Moreno

Autor

Autors aliens a IIS La Fe

Rades, Dirk
Al-Salool, Ahmed
Staackmann, Christian
Cremers, Florian
Cacicedo, Jon
Lomidze, Darejan
Segedin, Barbara
Groselj, Blaz
Jankarashvili, Natalia
Ciervide, Raquel
Kristiansen, Charlotte
Schild, Steven E.

Grups d'Investigació

Investigación Clínica y Traslacional en Cáncer

Leader

José Gómez Codina

Abstract

Simple Summary Since 2005, upfront surgery has been increasingly used in addition to radiotherapy for patients with malignant spinal cord compression (MSCC). As spinal surgery includes significant risks, careful patient selection is crucial. Individual risks and benefits should be considered when choosing an optimal treatment strategy. Benefits include preserving or regaining a patient's ambulatory function. To facilitate the decision pro or contra upfront surgery, a new prognostic score was developed to predict ambulatory status after radiotherapy alone. This clinical score was created from data of patients previously treated in prospective trials. It includes three prognostic groups (17-21, 22-31, and 32-37 points) with post-radiotherapy ambulatory rates of 10%, 65%, and 97%, respectively. Patients of the 32-37 points group may not require upfront surgery. The new instrument achieved very high accuracy in predicting post-radiotherapy ambulatory and non-ambulatory status and was more precise than a previous prognostic score in predicting non-ambulatory status. Estimating post-treatment ambulatory status can improve treatment personalization of patients irradiated for malignant spinal cord compression (MSCC). A new clinical score was developed from data of 283 patients treated with radiotherapy alone in prospective trials. Radiotherapy regimen, age, gender, tumor type, interval from tumor diagnosis to MSCC, number of affected vertebrae, other bone metastases, visceral metastases, time developing motor deficits, ambulatory status, performance score, sensory deficits, and sphincter dysfunction were evaluated. For factors with prognostic relevance in the multivariable logistic regression model after backward stepwise variable selection, scoring points were calculated (post-radiotherapy ambulatory rate in % divided by 10) and added for each patient. Four factors (primary tumor type, sensory deficits, sphincter dysfunction, ambulatory status) were used for the instrument that includes three prognostic groups (17-21, 22-31, and 32-37 points). Post-radiotherapy ambulatory rates were 10%, 65%, and 97%, respectively, and 2-year local control rates were 100%, 75%, and 88%, respectively. Positive predictive values to predict ambulatory and non-ambulatory status were 97% and 90% using the new score, and 98% and 79% using the previous instrument. The new score appeared more precise in predicting non-ambulatory status. Since patients with 32-37 points had high post-radiotherapy ambulatory and local control rates, they may not require surgery.

Dades de la publicació

ISSN/ISSNe:: 2072-6694, 2072-6694
Tipus:: Article
Pàgines:: -
DOI:: 10.3390/cancers14153827
PubMed:: 35954490
Factor d'Impacte:: 1,349 SCImago ℠
Quartil:: Q1 SCImago ℠

Documents

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Mètriques

Filiacions

Rades, Dirk:: 1 Universidad de Lubeck, Departamento Radiat Oncol, D-23562 Lubeck, Alemania, Lubeck, Alemania.
Al-Salool, Ahmed:: Univ Lubeck, Dept Radiat Oncol, D-23562 Lubeck, Germany
Staackmann, Christian:: Univ Lubeck, Dept Radiat Oncol, D-23562 Lubeck, Germany
Cremers, Florian:: Univ Lubeck, Dept Radiat Oncol, D-23562 Lubeck, Germany
Cacicedo, Jon:: Cruces Univ Hosp, Biocruces Hlth Res Inst, Dept Radiat Oncol, Baracaldo 48903, Spain
Lomidze, Darejan:: Tbilisi State Med Univ, Radiat Oncol Dept, GE-0177 Tbilisi, Georgia

Ingorokva High Med Technol Univ Clin, GE-0177 Tbilisi, Georgia
Segedin, Barbara:: Univ Ljubljana, Inst Oncol Ljubljana, Dept Radiotherapy, Ljubljana 1000, Slovenia

Univ Ljubljana, Fac Med, Ljubljana 1000, Slovenia
Groselj, Blaz:: Univ Ljubljana, Inst Oncol Ljubljana, Dept Radiotherapy, Ljubljana 1000, Slovenia

Univ Ljubljana, Fac Med, Ljubljana 1000, Slovenia
Jankarashvili, Natalia:: Acad F Todua Med Ctr, Res Inst Clin Med, Dept Radiat Oncol, GE-0112 Tbilisi, Georgia
Conde-Moreno, Antonio J.:: 8 Univ & Polytech Hosp La Fe, Dept Radiat Oncol, Valencia 46026, España, Valencia, España.
Ciervide, Raquel:: Univ Hosp HM Hosp, Dept Radiat Oncol, Madrid 28050, Spain
Kristiansen, Charlotte:: Univ Hosp Southern Denmark, Vejle Hosp, Dept Oncol, DK-7100 Vejle, Denmark
Schild, Steven E.:: Mayo Clin, Dept Radiat Oncol, Scottsdale, AZ 85259 USA