Abstract
BackgroundPatients with cancer of unknown primary account for 10% of patients with metastatic spinal cord compression (MSCC). This retrospective study was performed to identify prognostic factors for functional outcome, local control of MSCC, and survival in 175 of such patients treated with radiotherapy alone.MethodsInvestigated were nine potential prognostic factors including age, gender, Eastern Cooperative Oncology Group performance score (ECOG-PS), number of involved vertebrae, pre-radiotherapy ambulatory status, other bone metastases, visceral metastases, time developing motor deficits before radiotherapy, and the radiation schedule.ResultsOn multivariate analysis, better functional outcome was associated with absence of visceral metastases (estimate: 0.72; 95%-confidence interval [CI]: 0.07-1.36; p = 0.030) and a slower (>7 days) development of motor deficits (estimate: 1.93; 95%-CI: 1.18-2.68; p < 0.001). Improved local control of MSCC was associated with absence of visceral metastases (risk ratio [RR]: 10.26; 95%-CI: 2.11-74.73; p = 0.004). Improved survival was associated with favorable ECOG-PS (RR: 2.12; 95%-CI: 1.40-3.29; p < 0.001), being ambulatory prior to radiotherapy (RR: 1.98; 95%-CI: 1.40-2.81; p < 0.001), absence of visceral metastases (RR: 2.74; 95%-CI: 1.93-3.91; p < 0.001), and slower development of motor deficits (RR: 1.27; 95%-CI: 1.07-1.51; p = 0.007). Absence of other bone metastases showed a trend (RR: 1.38; 95%-CI: 0.98-1.95; p = 0.07).ConclusionsThis study identified additional independent prognostic factors for functional outcome, local control of MSCC, and survival after radiotherapy of MSCC from cancer of unknown primary. These prognostic factors can help select the best treatment regimen for each individual patient.
Highlights
Patients with cancer of unknown primary account for 10% of patients with metastatic spinal cord compression (MSCC)
This study aimed to identify independent prognostic factors for different endpoints including functional outcome, local control of MSCC, and survival in the largest series of patients with MSCC from cancer of unknown primary reported so far, in order to contribute to the personalization of the treatment of these patients
An improvement of motor function was significantly associated with absence of visceral metastases at the time of radiotherapy and slower (>7 days) development of motor deficits prior to the start of radiotherapy
Summary
Patients with cancer of unknown primary account for 10% of patients with metastatic spinal cord compression (MSCC). This retrospective study was performed to identify prognostic factors for functional outcome, local control of MSCC, and survival in 175 of such patients treated with radiotherapy alone. Up to 10% of adult cancer patients develop metastatic spinal cord compression (MSCC) during their disease [1,2]. To optimally take into account each patient’s individual situation, it is mandatory to personalize the local control of MSCC, and survival in the largest series of patients with MSCC from cancer of unknown primary reported so far, in order to contribute to the personalization of the treatment of these patients
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