A Simple Clinical Instrument to Predict the Survival Probability of Breast Cancer Patients Receiving Radiotherapy for Bone Metastases.
- 作者列表："Janssen S","Haus R","Schild SE","Rades D
BACKGROUND/AIM:Individualization of treatment may improve the outcome of patients with bone metastases from breast cancer. To support physicians when selecting individualized programs for these patients, a simple instrument for predicting survival was created. PATIENTS AND METHODS:In 126 female patients with breast cancer irradiated for bone metastases, 11 characteristics were evaluated with respect to survival. RESULTS:On Cox regression analysis, Eastern Cooperative Oncology Group performance score (0-1 vs. ≥2; p=0.032) and visceral metastases (absence vs. presence; p=0.017) were independently associated with survival and incorporated into the scoring instrument. Three prognostic groups (0, 1 or 2 points) were designated with 12-month survival rates of 38%, 57% and 91%, and 24-month survival rates of 32%, 36% and 80%, respectively (p<0.001). CONCLUSION:This easy-to-use scoring instrument allows physicians to estimate the lifespan of patients irradiated for bone metastases from breast cancer and can facilitate individualization of their treatment.
背景/目的: 个体化治疗可改善乳腺癌骨转移患者的预后。为了支持医生为这些患者选择个体化方案，创建了一个简单的预测生存率的工具。 患者和方法: 在 126 例因骨转移而接受放疗的女性乳腺癌患者中，评估了 11 项关于生存率的特征。 结果: 在Cox回归分析中，东部肿瘤协作组绩效评分 (0-1 vs. ≥ 2; p = 0。0 3 2) 和内脏转移 (不存在vs.存在; p = 0。0 1 7) 与生存率独立相关，并纳入评分工具。指定 3 个预后组 (0 、 1 或 2 分)，12 个 2 个月生存率为 38% 、 57% 和 9 1%，和 2 4 个月生存率分别为 3 2% 、 36% 和 8 0% (p<0。0 0 1)。 结论: 这种易于使用的评分工具使医生能够估计乳腺癌骨转移患者的寿命，并促进其治疗的个体化。
METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.