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Open Access Research article

Prognostic factors for different outcomes in patients with metastatic spinal cord compression from cancer of unknown primary

Sarah Douglas1, Stefan Huttenlocher1, Amira Bajrovic2, Volker Rudat3, Steven E Schild4 and Dirk Rades1*

Author Affiliations

1 Department of Radiation Oncology, University of Lubeck, Lubeck, Germany

2 Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

3 Department of Radiation Oncology, Saad Specialist Hospital Al-Khobar, Al-Khobar, Saudi Arabia

4 Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA

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BMC Cancer 2012, 12:261  doi:10.1186/1471-2407-12-261

Published: 21 June 2012

Abstract

Background

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.

Methods

Investigated 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.

Results

On 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).

Conclusions

This 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.

Keywords:
Prognostic factors; Cancer of unknown primary; Metastatic spinal cord compression; Radiotherapy; treatment outcomes