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Ji X, Li T, Liu F, Zhao Y, Li L, Guo G, Dong M, Gao X. Curettage of lesion combined with reconstruction of intramedullary nail and bone cement for the treatment of subtrochanteric metastatic tumors of the femur. Am J Cancer Res 2024; 14:2971-2983. [PMID: 39005686 PMCID: PMC11236769 DOI: 10.62347/sfey4389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/08/2024] [Indexed: 07/16/2024] Open
Abstract
This study investigated subtrochanteric femoral metastases using a retrospective approach by analyzing data from 109 patients with bone metastases (2015-2019). Surgical methods were compared: curettage with intramedullary nail and bone cement versus prosthetic reconstruction. Post-surgical assessments included joint function, bone metastasis-related serum markers, and complications. Univariate and multivariate logistic regression analysis was used to screen independent risk factors affecting patients' prognosis. R language was used to construct a nomogram model for predicting patients' 1- and 2-year survival, which was validated through ROC curves and the calibration chart. Patients treated with curettage showed superior postoperative outcomes, exhibiting significantly higher Karnofsky Performance Status (KPS) scores (80.00 vs. 70.00, P < 0.001) and Musculoskeletal Tumor Society Scores (MSTS) (23.86 ± 2.57 vs. 21.67 ± 3.24, P < 0.001). Both methods demonstrated comparable efficacy in pain control (VAS: 3.00 vs. 3.00, P > 0.05) and bone metabolism impact (ALP: 85.93 ± 14.44 vs. 83.19 ± 21.19; CTX-I: 3.03 ± 1.56 vs. 3.15 ± 1.75; PINP: 10.30 ± 4.41 vs. 11.57 ± 3.90; all P > 0.05). Cox regression identified treatment regimen, age, diabetes, and pre-treatment KPS score as significant survival factors (all P < 0.05). The nomogram model demonstrated high accuracy in predicting one-year and two-year survival (AUC: 0.821 and 0.790, respectively). In conclusion, curettage with intramedullary nail and bone cement enhances postoperative functional recovery and quality of life for subtrochanteric femoral metastases patients, representing a promising treatment method.
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Affiliation(s)
- Xubin Ji
- Trauma Orthopedics Department, Dongying People’s HospitalDongying 257091, Shandong, China
| | - Tianyan Li
- Health Materials Management Department, Dongying People’s HospitalDongying 257091, Shandong, China
| | - Fang Liu
- Dialysis Room, Dongying People’s HospitalDongying 257091, Shandong, China
| | - Yanmin Zhao
- Emergency Department, Dongying People’s HospitalDongying 257091, Shandong, China
| | - Liang Li
- Trauma Orthopedics Department, Dongying People’s HospitalDongying 257091, Shandong, China
| | - Guangming Guo
- Trauma Orthopedics Department, The People’s Hospital of Jimo QingdaoQingdao 266000, Shandong, China
| | - Minya Dong
- Cardiovascular Medicine Department, Dongying People’s HospitalDongying 257091, Shandong, China
| | - Xuede Gao
- Drug Clinical Trial Office, Dongying People’s HospitalDongying 257091, Shandong, China
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Steinvoort-Draat IN, Otto-Vollaard L, Quint S, Tims JL, de Pree IMN, Nuyttens JJ. Palliative radiotherapy: New prognostic factors for patients with bone metastasis. Cancer Radiother 2024; 28:236-241. [PMID: 38871605 DOI: 10.1016/j.canrad.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE Many cancer patients develop bone metastases, however the prognosis of overall survival differs. To provide an optimal treatment for these patients, especially towards the end of life, a reliable prediction of survival is needed. The goal of this study was to find new clinical factors in relation to overall survival. MATERIALS AND METHODS Prospectively 22 clinical factors were collected from 734 patients. The Kaplan-Meier and Cox regression models were used. RESULTS Most patients were diagnosed with lung cancer (29%), followed by prostate (19.8%) and breast cancer (14.7%). Median overall survival was 6.4months. Fourteen clinical factors showed significance in the univariate analyses. In the multivariate analyses 6 factors were found to be significant for the overall survival: Karnofsky performance status, primary tumor, gender, total organs affected, morphine use and systemic treatment options after radiotherapy. CONCLUSION Morphine use and systemic treatment options after radiotherapy, Karnofsky performance status, primary tumor, gender and total organs affected are strong prediction factors on overall survival after palliative radiotherapy in patients with bone metastasis. These factors are easily applicable in the clinic.
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Affiliation(s)
- I N Steinvoort-Draat
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - L Otto-Vollaard
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - S Quint
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - J L Tims
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - I M N de Pree
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - J J Nuyttens
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
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Davis MP, Vanenkevort E, Young A, Wojtowicz M, Gupta M, Lagerman B, Liu E, Mackley H, Panikkar R. Radiation Therapy in the Last Month of Life: Association With Aggressive Care at the End of Life. J Pain Symptom Manage 2023; 66:638-646. [PMID: 37657725 DOI: 10.1016/j.jpainsymman.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
CONTEXT Half of the patients with cancer who undergo radiation therapy do so with palliative intent. OBJECTIVES To determine the proportion of undergoing radiation in the last month of life, patient characteristics, cancer course, the type and duration of radiation, whether palliative care was involved, and the of radiation with aggressive cancer care metrics. METHODS One thousand seven hundred twenty-seven patients who died of cancer between January 1, 2018, and December 31, 2019, were included. Demographics, cancer stage, palliative care referral, advance directives, use of home health care, radiation timing, and survival were collected. Type of radiation, course, and intent were reviewed. Chi-square analysis was utilized for categorical variables, and Kruskal-Wallis tests for continuous variables. A stepwise selection was used to build a Cox proportional hazard model. RESULTS Two hundred thirty-three patients underwent radiation in the last month of life. Younger patients underwent radiation 67.3 years (SD 11.52) versus 69.2 years (SD 11.96). 42.6% had radiation within two weeks of death. The average fraction number was 5.5. Individuals undergoing radiation were more likely to start chemotherapy within the last 30 days of life, continue chemotherapy within two weeks of death, be admitted to the ICU, and have two or more hospitalizations or emergency room visits. Survival measured from the date of diagnosis was shorter for those undergoing radiation, 122 days (IQR 58-462) versus 474 days (IQR 225-1150). Palliative care consultations occurred later in those undergoing radiation therapy. CONCLUSION Radiation therapy in the last month of life occurs in younger patients with rapidly progressive cancer, who are subject to more aggressive cancer care, and have late palliative care consults.
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Affiliation(s)
- Mellar P Davis
- Department of Palliative Care (M.P.D.), Geisinger Medical Center, Danville, Pennsylvania.
| | - Erin Vanenkevort
- Department of Population and Health Science (E.V., A.Y.), Research Institute Geisinger Health System, Danville, Pennsylvania
| | - Amanda Young
- Department of Population and Health Science (E.V., A.Y.), Research Institute Geisinger Health System, Danville, Pennsylvania
| | - Mark Wojtowicz
- Oncology Research Department (M.W.), Cancer Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - Mudit Gupta
- Department of Phenomics Analytics and Clinical Data Core (M.G., B.L.), Geisinger Health System, Danville, Pennsylvania
| | - Braxton Lagerman
- Department of Phenomics Analytics and Clinical Data Core (M.G., B.L.), Geisinger Health System, Danville, Pennsylvania
| | - Edward Liu
- Geisinger Commonwealth School of Medicine (E.L.), Danville, Pennsylvania
| | - Heath Mackley
- Department of Radiation Oncology (H.M.), Geisinger Medical Center, Danville, Pennsylvania
| | - Rajiv Panikkar
- Knapper Cancer Center, Geisinger Medical Center (R.P.), Danville, Pennsylvania
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Ma X, Zhao Y, Zhao J, Wu H, Feng H. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracic and lumbar metastatic tumors. J Clin Transl Res 2023; 9:93-100. [PMID: 37033999 PMCID: PMC10075092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 01/12/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Aim With the greatly prolonged survival of cancer patients, more and more patients develop bone metastasis, especially spinal metastasis. Therefore, it is very important to choose the best surgical plan for patients with spinal metastasis in different conditions. This paper aims to evaluate the clinical efficacy of percutaneous pedicle screw fixation (PPSF) combined with percutaneous vertebroplasty (PVP) for the treatment of thoracic and lumbar metastatic tumors. Methods Forty patients with thoracic and lumbar metastatic tumors were treated with PPSF combined with PVP and followed up for 6-33 months. The visual analog scale (VAS) and the Barthel Index of activities of daily living (BIADL) were used to evaluate the pain intensity and quality of life before surgery and at 7 days, 3 months, and 6 months after the treatment. Results In this study, a total of 40 patients were followed up for 6-33 months (the mean time was 14.87 months). The VAS scores of all patients were significantly decreased, while the BIADL scores were significantly increased. No patients suffered from complications such as infection, pedicle screw loosening, or polymethylmethacrylate leakage. Spine stability was observed in all surviving patients during the follow-up. Conclusions PPSF combined with PVP is a new and viable treatment for thoracolumbar metastases in patients with a poor systemic condition, patients who refuse to undergo a conventional open procedure such as en bloc corpectomy, and in patients with vertebral instability or pathological fracture without significant spinal compression. Relevance for Patients Patients with spinal metastases have a great risk of spinal instability and even spinal cord compression while enduring pain. Therefore, timely and appropriate surgical treatment is an effective means to stabilize the spine and avoid spinal cord compression. PPSF combined with PVP is an effective new surgical method for the treatment of multilevel spinal metastases.
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Affiliation(s)
- Xiaowei Ma
- Departments of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Yi Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Jiazheng Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Hongzeng Wu
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Helin Feng
- Departments of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China
- Corresponding author: Helin Feng Departments of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China.
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Sun S, Krishnan M, Alcorn S. Prognostication for Patients Receiving Palliative Radiation Therapy. Semin Radiat Oncol 2023; 33:104-113. [PMID: 36990628 DOI: 10.1016/j.semradonc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Estimation of patient prognosis plays a central role in guiding decision making for the palliative management of metastatic disease, and a number of statistical models have been developed to provide survival estimates for patients in this context. In this review, we discuss several well-validated survival prediction models for patients receiving palliative radiotherapy to sites outside of the brain. Key considerations include the type of statistical model, model performance measures and validation procedures, studies' source populations, time points used for prognostication, and details of model output. We then briefly discuss underutilization of these models, the role of decision support aids, and the need to incorporate patient preference in shared decision making for patients with metastatic disease who are candidates for palliative radiotherapy.
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Performance of the Matsumiya scoring system in cervical cancer patients with bone metastasis: an external validation study. Int J Clin Oncol 2023; 28:321-330. [PMID: 36402825 DOI: 10.1007/s10147-022-02273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Accurate prognostic prediction of survival in cervical cancer patients with bone metastasis is important for treatment planning. We aimed to externally validate the Matsumiya scoring system using external patient data. METHODS We collected a retrospective cohort of patients with cervical cancer diagnosed with bone metastasis at Chiang Mai University Hospital from 1st January 2007 to 31st December 2016. The Matsumiya score was composed of 5 predictors, including the presence of extraskeletal metastasis, ECOG performance status, history of previous chemo- or radiotherapy, the presence of multiple bone metastasis, and bone metastasis-free interval < 12 months. Harrell's C-statistics and score calibration plots were used to evaluate the score performance. We also reconstructed the development study to estimate apparent performance values for comparison during external validation. RESULTS A total of 124 cervical cancer patients with bone metastasis were included in this study. The 13-, 26-, and 52-week survival probabilities in the validation study were 70.1%, 50.5%, and 25.7%, respectively. Several differences were identified between development and validation studies regarding clinical characteristics, case-mix, and predictor-outcome associations. Harrell's C-statistics in the development and validation study were 0.714 and 0.567. The score showed poor agreement between the observed and the predicted survival probabilities in the validation study. Score reweighting and refitting showed only modest improvement in performance. CONCLUSION A prognostic scoring system by Matsumiya et al. performed poorly in our cohort of Thai cervical cancer patients with bone metastasis. We suggested that the score should be sufficiently updated before being used.
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Yang W, Pan Q, Huang F, Hu H, Shao Z. Research progress of bone metastases: From disease recognition to clinical practice. Front Oncol 2023; 12:1105745. [PMID: 36761418 PMCID: PMC9905420 DOI: 10.3389/fonc.2022.1105745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/21/2022] [Indexed: 01/26/2023] Open
Abstract
Bone metastases, as one of the common types of metastatic tumors, have a great impact on the survival period and quality of life of patients. Bone metastases are usually characterized by bone destruction. Skeletal related events caused by bone destruction often lead to pain, pathological fractures and even paralysis. In this review, we provide a detailed explanation of bone metastases from the epidemiology, clinical features, pathogenesis, and recently developed clinical treatment viewpoints. We concluded that the incidence of bone metastases is increasing gradually, with serious clinical symptoms, complex pathogenesis and diverse clinical treatment. Tumor cells, immune cells, osteoblasts/osteoclasts and other cells as well as cytokines and enzymes all play a key role in the pathogenesis of bone metastases. We believe that the future treatment of bone metastases will be diversified and comprehensive. Some advanced technologies, such as nanomedicine, could be used for treatment, but this depends on understanding how disease occurs. With the development of treatment, the survival time and quality of life of patients will be improved.
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Affiliation(s)
| | | | | | - Hongzhi Hu
- *Correspondence: Hongzhi Hu, ; Zengwu Shao,
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Florez MA, De B, Cavazos A, Farooqi A, Beckham TH, Wang C, Yeboa DN, Bishop AJ, McAleer MF, Briere T, Amini B, Li J, Tatsui CE, Rhines LD, Ghia AJ. Safety and Efficacy of Dose-Escalated Radiation Therapy With a Simultaneous Integrated Boost for the Treatment of Spinal Metastases. Pract Radiat Oncol 2023; 13:e7-e13. [PMID: 36604100 DOI: 10.1016/j.prro.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Intensity modulated radiation therapy (RT) for spine metastases using a simultaneous integrated boost (SSIB) was shown as an alternative to the treatment of select osseous metastases that are not amenable to spine stereotactic radiosurgery. We sought to update our clinical experience using SSIB in patients for whom dose escalation was warranted but spine stereotactic radiosurgery was not feasible. METHODS AND MATERIALS A total of 58 patients with 63 spinal metastatic sites treated with SSIB between 2012 and 2021 were retrospectively reviewed. The gross tumor volume and clinical target volume were prescribed 40 and 30 Gy in 10 fractions, respectively. RESULTS The median follow-up time was 31 months. Of 79% of patients who reported pain before RT with SSIB, 82% reported an improvement following treatment. Patient-reported pain scores on a 10-point scale revealed a significant decrease in pain at 1, 3, 6, and 12 months after SSIB (P < .0001). Additionally, there were limited toxicities; only 1 patient suffered grade 3 toxicity (pain) following RT. There were no reports of radiation-induced myelopathy at last follow-up, and 8 patients (13%) experienced a vertebral column fracture post-treatment. Local control was 88% (95% confidence interval [CI], 80%-98%) and 74% (95% CI, 59%-91%) at 1 and 2 years, respectively. Overall survival was 64% (95% CI, 53%-78%) and 45% (95% CI, 34%-61%) at 1 and 2 years, respectively. The median overall survival was 18 months (95% CI, 13-27 months). Multivariable analysis using patient, tumor, and dosimetric characteristics revealed that a higher Karnofsky performance status before RT (hazard ratio, 0.44, 0.22-0.89; P = .02) was associated with longer survival. CONCLUSIONS These data demonstrate excellent pain relief and local control with limited acute toxicities following treatment with RT using SSIB to 40 Gy. Collectively, our data suggest that dose escalation to spine metastases using SSIB can be safe and efficacious for patients, especially those with radioresistant disease. Further investigation is warranted to validate these findings.
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Affiliation(s)
- Marcus A Florez
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian De
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adriana Cavazos
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahsan Farooqi
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas H Beckham
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chenyang Wang
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra N Yeboa
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary F McAleer
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tina Briere
- Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Behrang Amini
- Musculoskeletal Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Claudio E Tatsui
- Neurological Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laurence D Rhines
- Neurological Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amol J Ghia
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Functional and Survival Outcomes of Patients following the Harrington Procedure for Complex Acetabular Metastatic Lesions. Curr Oncol 2022; 29:5875-5890. [PMID: 36005202 PMCID: PMC9406529 DOI: 10.3390/curroncol29080464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The Harrington surgical technique makes it possible to manage complex, extensive bone lesions using pins and cement to consolidate bone for acetabular cup positioning. However, it may be associated with a high reoperation rate, and the functional results of this surgery are not precisely described in the literature. Methods: In a monocentric retrospective study including all patients operated on using the Harrington procedure associated with THA between 2005 and 2020, we aimed to assess preoperative and postoperative function, reoperation-free survival, and overall survival. Results: Functional improvement was significant for Parker scores (preoperative: 3.6 ± 2.0; 6-month follow-up: 6.6 ± 3.2; 12-month follow-up: 7.6 ± 2.1) and Musculoskeletal Tumor Society (MSTS) scores (preoperative: 31.1 ± 16.2%; 6-month follow-up: 67.7 ± 30.6%; 12-month follow-up: 82.4 ± 24.0%). Of the 21 patients included, the reoperation-free survival rate was 76.1% [CI 95%: 58.1–99.7] at six and twelve months, with the main complications being pin migration (50.0%) and infection (25%). The patient overall survival rate was 76.2% [95% CI: 59.9–96.7] at six months and 61.9% [95% CI: 59.9–96.7] at 12 months. Discussion: These results underlined significant functional improvements following a conventional Harrington procedure, with acceptable reoperation rates.
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Bone metastasis of hepatocellular carcinoma: facts and hopes from clinical and translational perspectives. Front Med 2022; 16:551-573. [DOI: 10.1007/s11684-022-0928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
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Sakurai T, Takamatsu S, Shimoyachi N, Shibata S, Makino M, Ohashi S, Taima Y, Minamikawa R, Kumano T, Gabata T. Prediction of post-radiotherapy survival for bone metastases: a comparison of the 3-variable number of risk factors model with the new Katagiri scoring system. JOURNAL OF RADIATION RESEARCH 2022; 63:303-311. [PMID: 34977925 PMCID: PMC8944300 DOI: 10.1093/jrr/rrab121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/18/2021] [Indexed: 05/08/2023]
Abstract
We investigated patient survival after palliative radiotherapy for bone metastases while comparing the prognostic accuracies of the 3-variable number of risk factors (NRF) model and the new Katagiri scoring system (Katagiri score). Overall, 485 patients who received radiotherapy for bone metastases were grouped as per the NRF model (groups I, II and III) and Katagiri score (low-, intermediate- and high-risk). Survival was compared using the log-rank or log-rank trend test. Independent prognostic factors were identified using multivariate Cox regression analyses (MCRA). MCRA and receiver operating characteristic (ROC) curves were used to compare both models' accuracy. For the 376 evaluable patients, the overall survival (OS) rates decreased significantly in the higher-tier groups of both models (P < 0.001). All evaluated factors except 'previous chemotherapy status' differed significantly between groups. Both models exhibited independent predictive power (P < 0.001). Per NRF model, hazard ratios (HRs) were 1.44 (P = 0.099) and 2.944 (P < 0.001), respectively, for groups II and III, relative to group I. Per Katagiri score, HRs for intermediate- and high-risk groups were 4.02 (P < 0.001) and 7.09 (P < 0.001), respectively, relative to the low-risk group. Areas under the curve (AUC) for predicting 6-, 18- and 24-month mortality were significantly higher when using the Katagiri score (P = 0.036, 0.039 and 0.022). Both models predict survival. Prognostic accuracy of the Katagiri score is superior, especially in patients with long-term survival potential; however, in patients with short prognosis, no difference occurred between both models; simplicity and patient burden should also be considered.
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Affiliation(s)
- Takayuki Sakurai
- Corresponding author. Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa 920-8641, Japan. Tel.: +81-76-265-2323; Fax: +81-76-234-4256;
| | - Shigeyuki Takamatsu
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Nana Shimoyachi
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Shibata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Mikoto Makino
- Department of Therapeutic Radiology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Shizuko Ohashi
- Radiation Therapy Center, Fukui Saiseikai Hospital, Fukui, Japan
| | - Yoko Taima
- Department of Therapeutic Radiology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Risako Minamikawa
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Tomoyasu Kumano
- Department of Radiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
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Mathis NJ, Doyle CJ, Rosen DB, Wijetunga NA, Vaynrub M, Bartelstein M, Guttmann DM, Brennan VS, Yamada YJ, Gillespie EF, Yerramilli D, Yang JT. Personalized Treatment Selection Leads to Low Rates of Local Salvage Therapy for Bone Metastases. Int J Radiat Oncol Biol Phys 2022; 112:99-105. [PMID: 34715255 PMCID: PMC9396633 DOI: 10.1016/j.ijrobp.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Local therapy for patients with nonspine bone metastases is evolving, with data supporting the use of single-fraction treatments, and more recently, showing possible benefit from stereotactic body radiation therapy (SBRT). However, the rate of local salvage therapy (LST) after each technique has not been characterized in real-world clinic settings where patients are selected at physician discretion. We examined rates of LST in patients with nonspine bone metastases. METHODS AND MATERIALS We reviewed records of RT for nonspine bone metastases at our institution from January 1, 2016, to December 31, 2018. We defined LST as the first occurrence of RT or surgery for oncologic progression to a bone metastasis after initial RT. Cumulative incidence functions for retreatment were generated. We conducted multivariate analysis to identify variables associated with LST. RESULTS A total of 1754 patients were analyzed, with median follow-up of 16.2 months (range, 0-36.8 months). Of all episodes of RT, 51.5% were multifraction external beam radiation therapy (EBRT), 7.0% were single-fraction EBRT, and 41.4% were SBRT. Altogether, 88 patients (5.0%) required LST, with an incidence at 6 months of 2.5%. Incidence of LST at 6 months was 2.1% for SBRT, 5.3% for single-fraction conventional regimens, and 2.4% for multifraction conventional regimens (P = .26). Patients of younger age, who had a higher Karnofsky performance status, and/or who had lesions in the pelvis had a higher risk of retreatment. CONCLUSIONS In this large institutional cohort, the rate of LST was low, with no difference between RT techniques. The findings indicated that SBRT for patients at high risk for treatment failure may reduce the rate of retreatment overall. When treatment modality was selected based on patient characteristics, rates of LST were lower than when treatment was randomly selected.
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Affiliation(s)
- Noah J. Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connor J. Doyle
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel B. Rosen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil A. Wijetunga
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Max Vaynrub
- Department of Orthopaedic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meredith Bartelstein
- Department of Orthopaedic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David M Guttmann
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victoria S Brennan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yoshiya J Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan T Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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13
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Itokazu M, Higashimoto Y, Ueda M, Hanada K, Murakami S, Fukuda K. Effectiveness of Rehabilitation for Cancer Patients with Bone Metastasis. Prog Rehabil Med 2022; 7:20220027. [PMID: 35633758 PMCID: PMC9113922 DOI: 10.2490/prm.20220027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Advances in cancer treatment have led to extended survival, and, as a result, the number of patients with bone metastases is increasing. Activities of daily living (ADL) decrease with bone metastasis and the need for rehabilitation is increasing. This study examined the effects of rehabilitation in patients with bone metastases. Methods: We retrospectively reviewed data of cancer patients with bone metastasis who received rehabilitation between 2016 and 2018. Efficacy of rehabilitation was evaluated in 92 patients as the change in the Functional Independence Measure (FIM) score divided by rehabilitation days (FIM change/day) and assessed by different metastatic sites. Results: Overall FIM scores significantly improved after rehabilitation. Moreover, FIM change/day improved in patients with pelvic metastases (n=44) more than in patients with other metastatic sites (n=48) (P=0.015). In FIM motor components, improvements in toilet, tub/shower, walk/wheelchair, and stairs were significantly greater in patients with pelvic metastasis than in those with other metastasis sites. Conclusions: Rehabilitation improved ADL status to a greater extent in patients with pelvic metastases than in those with other metastasis sites. Patients with pelvic metastases may fear fractures, limiting their ADL, but rehabilitation could eliminate this fear and improve FIM.
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Affiliation(s)
- Maki Itokazu
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Kindai University, Osakasayama City, Japan
| | - Yuji Higashimoto
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Kindai University, Osakasayama City, Japan
| | - Masami Ueda
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Kindai University, Osakasayama City, Japan
| | - Kazushi Hanada
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Kindai University, Osakasayama City, Japan
| | - Saori Murakami
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Kindai University, Osakasayama City, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Kindai University, Osakasayama City, Japan
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14
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Ignat P, Todor N, Ignat RM, Șuteu O. Prognostic Factors Influencing Survival and a Treatment Pattern Analysis of Conventional Palliative Radiotherapy for Patients with Bone Metastases. Curr Oncol 2021; 28:3876-3890. [PMID: 34677249 PMCID: PMC8534390 DOI: 10.3390/curroncol28050331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Treatment indication for bone metastases is influenced by patient prognosis. Single-fraction radiotherapy (SFRT) was proven equally effective as multiple fractionation regimens (MFRT) but continues to be underused. OBJECTIVE Primary objectives: (a) to identify prognostic factors for overall survival and (b) to analyze treatment patterns of palliative radiotherapy (proportion of SFRT indication and predictive factors of radiotherapy regimen) for bone metastases. METHODS 582 patients with bone metastases who underwent conventional radiotherapy between January 1st 2014-31 December 2017 were analyzed. The Cox proportional hazard model was used to identify predictors of overall survival. For the treatment pattern analysis, 677 radiotherapy courses were evaluated. The logistic regression model was used to identify potential predictors of radiotherapy regimen. RESULTS The 3-year overall survival was 15%. Prognostic factors associated with poor overall survival were multiple bone metastases [hazard ratio (HR = 5.4)], poor performance status (HR = 1.5) and brain metastases (HR = 1.37). SFRT prescription increased from 41% in 2017 to 51% in 2017. Predictors of SFRT prescription were a poor performance status [odds ratio (OR = 0.55)], lung (OR = 0.49) and urologic primaries (OR = 0.33) and the half-body lower site of irradiation (OR = 0.59). Spinal metastases were more likely to receive MFRT (OR = 2.09). CONCLUSIONS Based on the prognostic factors we identified, a selection protocol for patients candidates for palliative radiotherapy to bone metastases could be established, in order to further increase SFRT prescription in our institution.
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Affiliation(s)
- Patricia Ignat
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (P.I.); (O.Ș.)
- Prof. Dr. I. Chiricuță Oncology Institute, 400015 Cluj-Napoca, Romania;
| | - Nicolae Todor
- Prof. Dr. I. Chiricuță Oncology Institute, 400015 Cluj-Napoca, Romania;
| | - Radu-Mihai Ignat
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (P.I.); (O.Ș.)
- Correspondence:
| | - Ofelia Șuteu
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (P.I.); (O.Ș.)
- Prof. Dr. I. Chiricuță Oncology Institute, 400015 Cluj-Napoca, Romania;
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15
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Lasagna A, Cuzzocrea F, Maccario G, Mahagna A, Sacchi P, U Mondelli M. Bone metastases and hepatocellular carcinoma: some food for thought. Future Oncol 2021; 17:3777-3780. [PMID: 34313153 DOI: 10.2217/fon-2021-0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, Pavia 27100, Italy
| | - Fabrizio Cuzzocrea
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, Pavia 27100, Italy
| | - Gaia Maccario
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, Pavia 27100, Italy
| | - Antonio Mahagna
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, Pavia 27100, Italy
| | - Paolo Sacchi
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, Pavia 27100, Italy
| | - Mario U Mondelli
- Division of Infectious Diseases & Immunology, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, Pavia 27100, Italy
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16
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Ning MS, Das P, Rosenthal DI, Dabaja BS, Liao Z, Chang JY, Gomez DR, Klopp AH, Gunn GB, Allen PK, Nitsch PL, Natter RB, Briere TM, Herman JM, Wells R, Koong AC, McAleer MF. Early and Midtreatment Mortality in Palliative Radiotherapy: Emphasizing Patient Selection in High-Quality End-of-Life Care. J Natl Compr Canc Netw 2021; 19:805-813. [PMID: 33878727 DOI: 10.6004/jnccn.2020.7664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Palliative radiotherapy (RT) is effective, but some patients die during treatment or too soon afterward to experience benefit. This study investigates end-of-life RT patterns to inform shared decision-making and facilitate treatment consistent with palliative goals. MATERIALS AND METHODS All patients who died ≤6 months after initiating palliative RT at an academic cancer center between 2015 and 2018 were identified. Associations with time-to-death, early mortality (≤30 days), and midtreatment mortality were analyzed. RESULTS In total, 1,620 patients died ≤6 months from palliative RT initiation, including 574 (34%) deaths at ≤30 days and 222 (14%) midtreatment. Median survival was 43 days from RT start (95% CI, 41-45) and varied by site (P<.001), ranging from 36 (head and neck) to 53 days (dermal/soft tissue). On multivariable analysis, earlier time-to-death was associated with osseous (hazard ratio [HR], 1.33; P<.001) and head and neck (HR, 1.45; P<.001) sites, multiple RT courses ≤6 months (HR, 1.65; P<.001), and multisite treatments (HR, 1.40; P=.008), whereas stereotactic technique (HR, 0.77; P<.001) and more recent treatment year (HR, 0.82; P<.001) were associated with longer survival. No difference in time to death was noted among patients prescribed conventional RT in 1 to 10 versus >10 fractions (median, 40 vs 47 days; P=.272), although the latter entailed longer courses. The 30-day mortality group included 335 (58%) inpatients, who were 27% more likely to die midtreatment (P=.031). On multivariable analysis, midtreatment mortality among these inpatients was associated with thoracic (odds ratio [OR], 2.95; P=.002) and central nervous system (CNS; OR, 2.44; P=.002) indications, >5-fraction courses (OR, 3.27; P<.001), and performance status of 3 to 4 (OR, 1.63; P=.050). Conversely, palliative/supportive care consultation was associated with decreased midtreatment mortality (OR, 0.60; P=.045). CONCLUSIONS Earlier referrals and hypofractionated courses (≤5-10 treatments) should be routinely considered for palliative RT indications, given the short life expectancies of patients at this stage in their disease course. Providers should exercise caution for emergent thoracic and CNS indications among inpatients with poor prognoses due to high midtreatment mortality.
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Affiliation(s)
| | | | | | | | | | | | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Paige L Nitsch
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Tina M Briere
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph M Herman
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health, Houston, Texas; and
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17
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Elledge CR, LaVigne AW, Fiksel J, Wright JL, McNutt T, Kleinberg LR, Hu C, Smith TJ, Zeger S, DeWeese TL, Alcorn SR. External Validation of the Bone Metastases Ensemble Trees for Survival (BMETS) Machine Learning Model to Predict Survival in Patients With Symptomatic Bone Metastases. JCO Clin Cancer Inform 2021; 5:304-314. [PMID: 33760638 DOI: 10.1200/cci.20.00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The Bone Metastases Ensemble Trees for Survival (BMETS) model uses a machine learning algorithm to estimate survival time following consultation for palliative radiation therapy for symptomatic bone metastases (SBM). BMETS was developed at a tertiary-care, academic medical center, but its validity and stability when applied to external data sets are unknown. PATIENTS AND METHODS Patients treated with palliative radiation therapy for SBM from May 2013 to May 2016 at two hospital-based community radiation oncology clinics were included, and medical records were retrospectively reviewed to collect model covariates and survival time. The Kaplan-Meier method was used to estimate overall survival from consultation to death or last follow-up. Model discrimination was estimated using time-dependent area under the curve (tAUC), which was calculated using survival predictions from BMETS based on the initial training data set. RESULTS A total of 216 sites of SBM were treated in 182 patients. Most common histologies were breast (27%), lung (23%), and prostate (23%). Compared with the BMETS training set, the external validation population was older (mean age, 67 v 62 years; P < .001), had more primary breast (27% v 19%; P = .03) and prostate cancer (20% v 12%; P = .01), and survived longer (median, 10.7 v 6.4 months). When the BMETS model was applied to the external data set, tAUC values at 3, 6, and 12 months were 0.82, 0.77, and 0.77, respectively. When refit with data from the combined training and external validation sets, tAUC remained > 0.79. CONCLUSION BMETS maintained high discriminative ability when applied to an external validation set and when refit with new data, supporting its generalizability, stability, and the feasibility of dynamic modeling.
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Affiliation(s)
- Christen R Elledge
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna W LaVigne
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacob Fiksel
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Todd McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lawrence R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chen Hu
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Thomas J Smith
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Theodore L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sara R Alcorn
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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18
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Radeczky P, Megyesfalvi Z, Laszlo V, Fillinger J, Moldvay J, Raso E, Schlegl E, Barbai T, Timar J, Renyi-Vamos F, Dome B, Hegedus B. The effects of bisphosphonate and radiation therapy in bone-metastatic lung adenocarcinoma: the impact of KRAS mutation. Transl Lung Cancer Res 2021; 10:675-684. [PMID: 33718013 PMCID: PMC7947398 DOI: 10.21037/tlcr-20-754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background KRAS mutation is the most common genetic alteration in lung adenocarcinoma (LADC) in Western countries and is associated with worse outcome in bone-metastatic cases. Yet, to date, no effective treatment guidelines were developed for these patients. Accordingly, our aim was to investigate the impact of KRAS mutation on bisphosphonate (BTx) and radiation therapy (RTx) in bone-metastatic LADC patients. Methods Clinicopathological variables of 134 consecutive LADC patients with bone metastases at diagnosis and known KRAS status were retrospectively analyzed. The effects of BTx, RTx and KRAS mutation on overall survival (OS) were investigated. Results Of the total cohort, 93 patients were identified as KRAS wild-type (WT) (69.4%) and 41 (30.6%) as KRAS mutant patients. The presence of KRAS mutation was associated with significantly reduced median OS (5.1 vs. 10.2 months in KRAS WT patients; P=0.008). Irrespective of KRAS mutational status both BTx (P=0.007) and RTx (P=0.021) conferred a significant benefit for OS. Notably, however, when analyzing the patients with KRAS-mutant and KRAS WT tumors separately, the benefit from BTx and RTx on OS remained statistically significant only in KRAS WT patients (P=0.032 and P=0.031, respectively). Conclusions KRAS mutation is a strong negative prognostic factor in bone-metastatic LADC patients. Both BTx and RTx can increase the OS with a pronounced benefit for patients with KRAS WT tumors. Altogether, KRAS mutational status should be considered during therapeutic decision making in bone-metastatic LADC patients.
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Affiliation(s)
- Peter Radeczky
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Zsolt Megyesfalvi
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Viktoria Laszlo
- National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Janos Fillinger
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Moldvay
- National Koranyi Institute of Pulmonology, Budapest, Hungary.,MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Budapest, Hungary
| | - Erzsebet Raso
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | | | - Tamas Barbai
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Jozsef Timar
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary.,Tumor Progression Research Group, Hungarian Academy of Sciences-Semmelweis University, Budapest, Hungary
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Balazs Dome
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Balazs Hegedus
- Department of Thoracic Surgery, Ruhrlandklinik, University Clinic Essen, Essen, Germany
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19
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Prognostic Factors in the New Katagiri Scoring System After Palliative Surgery for Spinal Metastasis. Spine (Phila Pa 1976) 2020; 45:E813-E819. [PMID: 32044810 DOI: 10.1097/brs.0000000000003415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The purpose of the study was to examine survival after surgery for a metastatic spinal tumor using prognostic factors in the new Katagiri score. SUMMARY OF BACKGROUND DATA Surgery for spinal metastasis can improve quality of life and facilitate treatment of the primary cancer. However, choice of therapy requires identification of prognostic factors for survival, and these may change over time due to treatment advances. The new Katagiri score for the prognosis of skeletal metastasis includes classification of the primary tumor site and the effects of chemotherapy and hormonal therapy. METHODS The subjects were 201 patients (127 males, 74 females) who underwent surgery for spinal metastases at six facilities in the Nagoya Spine Group. Age at surgery, gender, follow-up, metastatic spine level, primary cancer, new Katagiri score (including primary site, visceral metastasis, laboratory data, performance status (PS), and chemotherapy) and survival were obtained from a prospectively maintained database. RESULTS Posterior decompression (n = 29) and posterior decompression and fixation with instrumentation (n = 182) were performed at a mean age of 65.9 (range, 16-85) years. Metastasis was present in the cervical (n = 19, 10%), thoracic (n = 155, 77%), and lumbar (n = 26, 13%) spine, and sacrum (n = 1, 1%). In multivariate analysis, moderate growth (HR 2.95, 95% CI, 1.27-7.89, P < 0.01) and rapid growth (HR 4.71, 95% CI, 2.78-12.31, P < 0.01) at the primary site; nodular metastasis (HR 1.53, 95% CI, 1.07-3.85, P < 0.01) and disseminated metastasis (HR 2.94, 95% CI, 1.33-5.42, P < 0.01); and critical laboratory data (HR 3.15, 95% CI, 2.06-8.36, P < 0.01), and poor PS (HR 2.83, 95% CI, 1.67-4.77, P < 0.01) were significantly associated with poor survival. CONCLUSION Accurate prognostic factors are important in deciding the treatment strategy in patients with spinal metastasis, and our identification of these factors may be useful for these patients. LEVEL OF EVIDENCE 3.
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