Clinical Investigation
A Score Predicting Posttreatment Ambulatory Status in Patients Irradiated for Metastatic Spinal Cord Compression

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Purpose

To create a scoring system to predict ambulatory status after radiotherapy (RT) for metastatic spinal cord compression (MSCC).

Methods and Materials

On the basis of a multivariate analysis of 2096 MSCC patients, a scoring system was developed. This included the five prognostic factors significantly associated with post-RT ambulatory status: primary tumor type, interval between tumor diagnosis and MSCC, visceral metastases, motor function before RT, and time developing motor deficits before RT. The score for each factor was determined by dividing the post-RT ambulatory rate (as a percentage) by 10. Total scores represented the sum of the scores for each factor and ranged between 21 and 44 points. Patients were divided into five groups according to this score.

Results

The post-RT ambulatory rates were 6% (24 of 389) for patients with scores of ≤28 points, 44% (121 of 278) for those with 29–31 points, 70% (212 of 303) for those with 32–34 points, 86% (315 of 266) for those with 35–37 points, and 99% (750 of 760) for those with ≥38 points. The 3-month survival rates were 29%, 62%, 77%, 84%, and 98%, respectively. The 6-months survival rates were 6%, 31%, 42%, 61%, and 93%, respectively.

Conclusions

Because patients with scores of ≤28 points had poor functional outcome after RT and extraordinarily poor survival rates, short-course RT to decrease pain or best supportive care may be considered. Patients with scores of 29–37 points should be considered surgical candidates, because RT-alone results were not optimal. Patients with scores of ≥38 points seem to have excellent results with RT alone.

Introduction

Radiotherapy (RT) alone is the most frequently applied treatment for metastatic spinal cord compression (MSCC). However, results from a small Phase III trial strongly suggested that selected MSCC patients benefit more from decompressive surgery plus RT than from RT alone (1). On the other hand, patients with oligometastatic disease and favorable prognostic factors seem to be well treated with RT alone (2). Thus more data are required to better define subsets of MSCC patients who would benefit from one particular therapy.

The present study was performed to create a score that allows one to predict the effect of RT on motor function. Regaining or maintaining ambulatory status can be considered the most important endpoint for MSCC patients with motor deficits. Therefore the score was designed to predict ambulatory status after RT (post-RT ambulatory status). It can be considered a simple tool that may help the clinician select the appropriate treatment regimen for the individual MSCC patient.

Section snippets

Methods and Materials

The score is based on a multivariate analysis of 2096 retrospectively reviewed patients who were irradiated for MSCC between January 1992 and June 2007. The patients were irradiated at the contributing centers during a certain period. Thus each series from a contributing center represented an unselected series of MSCC patients. The multivariate analysis was performed with logistic regression and the backward stepwise (likelihood ratio) method. Of the 11 investigated potential prognostic

Results

The post-RT ambulatory rate was 68% (1422 of 2096 patients) in the entire cohort. The rates related to the five groups were 6% (24 of 389) for patients with a total score of ≤28 points, 44% (121 of 278) for those with a score of 29–31 points, 70% (212 of 303) for those with a score of 32–34 points, 86% (315 of 366) for those with a score of 35–37 points, and 99% (750 of 760) for those with a score of ≥38 points. These results are demonstrated in Fig. 2.

The 3-month survival rates in the five

Discussion

In this study a scoring system was created with the potential to predict the ambulatory status of patients irradiated for MSCC. According to the score, five groups (A–E) were formed. Patients of Group A (scores of ≤28 points) had ambulatory rates of <10% after RT. Patchell et al.(1) reported an ambulatory rate of 84% after decompressive surgery plus RT. Therefore, one might consider patients with a score of ≤28 points as good candidates for surgery. However, the survival of these patients was

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    Citation Excerpt :

    No single scoring system has been shown to have greater predictive power. There is one scoring system to predict post radiotherapy ambulatory outcomes in patients with MSCC based on a previous retrospective analysis, also shown in Table 3 [59]. MRI-whole spine is the investigation of choice for suspected metastatic spinal cord compression and should be performed urgently within 24 h of presentation

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Conflict of interest: none.

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