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Vienna, Austria

ESTRO 2023

Session Item

Mixed sites/palliation
Poster (Digital)
Clinical
Survival prognosis of elderly patients irradiated for spinal bone metastases with a new scoring tool
Nils Nicolay, Germany
PO-1600

Abstract

Survival prognosis of elderly patients irradiated for spinal bone metastases with a new scoring tool
Authors:

Tilman Bostel1,2, Daniel Wollschläger3, Julian Geis1,4, Eirini Nikolaidou1,4, Alexander Fabian5,6,7, Nils Henrik Nicolay5,6,8, Heinz Schmidberger9,2

1University Medical Center Mainz, Department of Radiation Oncology , Mainz, Germany; 2German Cancer Research Center (dkfz), German Cancer Consortium (DKTK) Partner Site Mainz, Heidelberg , Germany; 3University Medical Center Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany; 4German Cancer Research Center (dkfz), German Cancer Consortium (DKTK) Partner Site Mainz, Heidelberg, Germany; 5University of Freiburg – Medical Center, Department of Radiation Oncology , Freiburg, Germany; 6German Cancer Research Center (dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Heidelberg, Germany; 7University Hospital Schleswig-Holstein, Department of Radiation Oncology, Kiel, Germany; 8University of Leipzig Medical Center, Department of Radiation Oncology , Leipzig , Germany; 9University Medical Center Mainz , Department of Radiation Oncology , Mainz, Germany

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Purpose or Objective

For personalized therapy of patients with bone metastases, the remaining lifetime should be estimated using scoring tools if possible. The aim of this analysis was to develop a new tool specifically designed for elderly patients with spinal bone metastases (SBM) to estimate their 12- and 24-month survival rates.  

Material and Methods

This retrospective analysis included 212 elderly patients with SBM (median age 76 years, range 65-90 years) treated with palliative radiotherapy (RT) in the period 2015 to 2020 at the University Medical Center Mainz.  
The most common underlying primaries were prostate (n=60, 28%), breast (n=36, 17%), and lung (n=43, 20%) carcinomas. Multiple patient-, tumor-, and treatment-specific factors were documented, and their prognostic relevance for predicting residual survival after palliative RT was statistically analyzed. Factors achieving significance (p < 0.05) on multivariate analysis were used for score development.

Results

In multivariate analysis, the following 3 factors were associated with significant improvement in survival after palliative RT for spinal bone metastases:

1.    Karnofsky Performance Score (<80% vs.≥80%, HR=0.47, p=0.001)

2.    ACE-27 comorbidity score (0-1 vs. 2-3, HR=0.49, p<0.001)

3.    Primary tumor type (breast carcinoma: HR=0.35, p=0.007; prostate carcinoma: HR=0.46, p=0.012; lung carcinomas were chosen as the reference variable)

These factors were considered for the scoring tool. Because the hazard ratios of the significant factors were close to each other, the presence of any positive prognostic factor was assigned 1 point, resulting in 4 prognostic groups with 0 to 3 points accordingly (A: 3 points, B: 2 points, C=1 point, D=0 points). Survival rates at 12 and 24 months were 92% and 69% in group A, 64% and 48% in group B, 31% and 18% in group C, and 16% and 6% in group D, respectively; median survival rates were 44.4 months (95% CI 23.1-65.6 months), 23.5 months (95% CI 17.6-29.4 months), 5.2 months (95% CI 3.9-6.6 months), and 2.6 months (95% CI 1.4-3.8 months) in the respective groups.

Conclusion

For the first time, this study could demonstrate that in addition to general condition and tumor histology, comorbidities play a central role in survival prognostication of elderly patients after palliative RT of SBM. Therefore, the proposed new tool may support radiation oncologists when assigning RT to elderly patients with SBM. External validation of the scoring tool is ongoing.