Survival evaluation of malignant epidural spinal wire compression after palliative radiotherapy utilizing Tokuhashi scoring system and the affect of systemic remedy.
Ann Palliat Med. 2017 Dec;6(Suppl 2):S132-S139
Authors: Mui WH, Lam TC, Wong FCS, Sze WK
BACKGROUND: Earlier research have proven comparable medical outcomes of each single and multi-fraction (Fr) radiation remedy amongst malignant epidural spinal wire compression (MSCC) sufferers with poor prognosis; whereas, sufferers anticipated to have longer survival might require long-course radiotherapy to stop native failure. Nevertheless, such a poor prognosis threat group has not but been clearly recognized to be used in each day medical apply. We examined if the identified predictive Tokuhashi scoring system could possibly be tailored in MSCC sufferers handled with palliative radiation remedy.
METHODS: A retrospective evaluate of the therapy outcomes of MSCC sufferers who acquired palliative radiotherapy from January 2014 to Might 2015 was carried out. The sufferers had been stratified into two teams based on the Tokuhashi scoring system: group 1 (rating <9), anticipated survival <6 months, and group 2 (rating >eight), anticipated survival >6 months. Their survival was examined in opposition to subsequent systemic remedy (chemotherapy, focused or hormonal remedy) and different threat elements together with age, main web site, visceral metastasis, baseline motor operate, prior radiotherapy and radiotherapy fractionation (single or a number of).
RESULTS: The outcomes of 119 sufferers had been studied, 116 (97.5%) sufferers had already succumbed. The general median survival was 55 days (vary, Four-576 days). Ninety-three sufferers (78.2%) belonged to group 1. The median dose delivered was 25 Gy in 5 Frs [range, 7 Gy in 2 Frs-40 Gy in 10 Frs (to the cauda equina)]. Solely 9 sufferers (7.6%) acquired single-Fr radiotherapy, all belonging to Tokuhashi group 1. Sufferers belonging to group 1 had shorter median survival than group 2; 49 and 108 days, respectively (P=Zero.003). Amongst all of the sufferers, subsequent systemic therapy [hazard ratio (HR) =0.407; 95% confidence interval (CI), 0.236-0.702; P=0.001], non-visceral metastasis (HR =Zero.608; 95% CI, Zero.387-Zero.956; P=Zero.031) and first lung or breast or prostate most cancers (P=Zero.029) had been related to higher survival in multivariate evaluation. For sufferers in group 1, main breast or prostate most cancers (HR =Zero.264; 95% CI, Zero.122-Zero.572; P=Zero.001) or lung most cancers (HR =Zero.421; 95% CI, Zero.246-Zero.719; P=Zero.002), non-visceral metastasis (HR =Zero.453; 95% CI, Zero.264-Zero.777; P=Zero.004), multi-Fr (HR =Zero.455; 95% CI, Zero.217-Zero.956; P=Zero.038) and subsequent systemic remedy (HR =Zero.460; 95% CI, Zero.252-Zero.842; P=Zero.012) had been related to higher survival. The survival of a subset of sufferers in group 1 with out subsequent systemic remedy was dismal (median survival solely 40 days) and never altered by radiotherapy schedule (P=Zero.189).
CONCLUSIONS: MSCC includes a really heterogenous group of sufferers, even underneath the Tokuhashi grouping. Systemic remedy or visceral metastasis could also be extra necessary prognostic elements. Additional research are obligatory to raised choose the poor prognosis threat group. In medical apply, single-Fr radiotherapy could possibly be thought-about in Tokuhashi group 1 sufferers resulting from their anticipated quick survival, particularly for these with out affordable systemic therapy choices.
PMID: 29156895 [PubMed – indexed for MEDLINE]