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Title: An Easy Tool to Predict Survival in Patients Receiving Radiation Therapy for Painful Bone Metastases

Purpose: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and patient-reported scores of pain and quality of life, to predict survival in patients with painful bone metastases. Methods and Materials: In the Dutch Bone Metastasis Study, 1157 patients were treated with radiation therapy for painful bone metastases. At randomization, physicians determined the KPS; patients rated general health on a visual analogue scale (VAS-gh), valuation of life on a verbal rating scale (VRS-vl) and pain intensity. To assess the predictive value of the variables, we used multivariate Cox proportional hazard analyses and C-statistics for discriminative value. Of the final model, calibration was assessed. External validation was performed on a dataset of 934 patients who were treated with radiation therapy for vertebral metastases. Results: Patients had mainly breast (39%), prostate (23%), or lung cancer (25%). After a maximum of 142 weeks' follow-up, 74% of patients had died. The best predictive model included sex, primary tumor, visceral metastases, KPS, VAS-gh, and VRS-vl (C-statistic = 0.72, 95% CI = 0.70-0.74). A reduced model, with only KPS andmore » primary tumor, showed comparable discriminative capacity (C-statistic = 0.71, 95% CI = 0.69-0.72). External validation showed a C-statistic of 0.72 (95% CI = 0.70-0.73). Calibration of the derivation and the validation dataset showed underestimation of survival. Conclusion: In predicting survival in patients with painful bone metastases, KPS combined with primary tumor was comparable to a more complex model. Considering the amount of variables in complex models and the additional burden on patients, the simple model is preferred for daily use. In addition, a risk table for survival is provided.« less
Authors:
 [1] ;  [2] ;  [3] ; ;  [4] ;  [5] ;  [1] ;  [6] ; ;  [7]
  1. Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)
  2. Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands)
  3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands)
  4. Department of Orthopedic Surgery, Leiden University Medical Center (Netherlands)
  5. ARTI Institute for Radiation Oncology Arnhem, Arnhem (Netherlands)
  6. Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen (Netherlands)
  7. Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands)
Publication Date:
OSTI Identifier:
22420459
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 90; Journal Issue: 4; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CALIBRATION; COMPARATIVE EVALUATIONS; HAZARDS; LUNGS; MAMMARY GLANDS; METASTASES; MULTIVARIATE ANALYSIS; NEOPLASMS; PAIN; PATIENTS; RADIOTHERAPY; SKELETON; STANDARD OF LIVING