Rades et al developed a score for predicting survival in a patient undergoing radiotherapy for metastatic spinal cord compression. The authors are from University Hospital Schleswig-Holstein and Mayo Clinic Scottsdale.
Parameters:
(1) primary tumor type
(2) metastases to nonvertebral bone at the time of radiotherapy
(3) visceral metastases at the time of radiotherapy
(4) interval in months between tumor diagnosis and onset of spinal cord compression
(5) ambulatory status prior to radiotherapy
(6) time to develop motor deficits before radiotherapy
|
Parameter |
Finding |
Points |
|
primary tumor type |
myeloma or lymphoma |
9 |
|
|
breast cancer |
8 |
|
|
prostate cancer |
7 |
|
|
other |
4 |
|
|
lung cancer |
3 |
|
metastases to other bones |
no |
7 |
|
|
yes |
5 |
|
visceral metastases |
no |
8 |
|
|
yes |
2 |
|
interval between tumor diagnosis and spinal cord compression |
> 15 months |
7 |
|
|
<= 15 months |
4 |
|
ambulatory status |
ambulatory |
7 |
|
|
nonambulatory |
3 |
|
time to develop motor deficit before radiation therapy |
> 14 days |
8 |
|
|
8 to 14 days |
6 |
|
|
<= 7 days |
3 |
where:
• According to the example given on page 158, time to develop motor deficits seems to be the time between the onset of a motor deficit and start of radiotherapy.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 20
• maximum score: 46
• The higher the score the better the survival.
|
Total Score |
Group |
50% Mortality |
100% Mortality |
|
20 to 25 |
A |
2 months |
12 months |
|
26 to 30 |
B |
4 months |
18 months |
|
31 to 35 |
C |
6 months |
60 months |
|
36 to 40 |
D |
23 months |
> 70 months |
|
41 to 46 |
E |
62 months |
> 70 months |
Management decision:
(1) Short-term radiation therapy is appropriate for groups A and B.
(2) Long-course radiation therapy is appropriate for groups D and E.
(3) Group C is in a grey zone that could benefit from either strategy depending on the patient. Most patient would benefit from short-term radiation therapy but those surviving longer might be considered for long-course therapy.
Purpose: To predict survival in a patient undergoing radiation therapy for metastatic spinal cord compression using the score of Rades et al.
Specialty: Hematology Oncology, Surgery, general
Objective: severity, prognosis, stage, response to therapy, end-of-life, palliative care, interventional radiology
ICD-10: C00-C14, C15-C26, C30-C39, C40-C41, C43-C44, C45-C49, C50-C50, C51-C58, C60-C63, C64-C68, C69-C72, C73-C75, C76-C80, C81-C96, C97-C97,
