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Castelló de la Plana, Spain

Rades D.,University of Lubeck | Conde-Moreno A.J.,Consorcio Hospital Provincial de Castellon | Garcia R.,Consorcio Hospital Provincial de Castellon | Veninga T.,Dr Bernard Verbeeten Institute | Schild S.E.,Mayo Medical School
Anticancer Research | Year: 2015

Aim: Cancers of unknown primary (CUP) account for about 10% in elderly patients with MESCC. Immediate treatment is indicated. Personalizing treatment for MESCC requires for clear understanding of the patients' survival prognosis. In this case, a tool for estimating survival would be valuable. Patients and Methods: In 104 elderly CUP patients, nine factors were investigated: age, gender, performance score, number of affected vertebrae, ability to walk at presentation for radiotherapy, additional bone metastases, visceral metastases, time developing motor weakness, radiotherapy program. Results: In multivariate analysis, the ability to walk (p=0.011) and visceral metastases (p<0.001) were associated with survival. The following scores were assigned: unable to walk=0, able to walk=1, visceral metastases=0, no visceral metastases=1. Three groups were formed (0, 1 and 2 points) with 6-month survival rates of 7%, 18% and 73% (p<0.001). Conclusion: This specific tool assists the physician to estimate survival and select for the most suitable radiotherapy program in elderly CUP patients with MESCC. Source


Rades D.,University of Lubeck | Conde-Moreno A.J.,Consorcio Hospital Provincial de Castellon | Cacicedo J.,Cruces University Hospital | Segedin B.,Oncology and Radiotherapy Institute | And 2 more authors.
Anticancer Research | Year: 2015

Aim: Metastatic spinal cord compression (MSCC) is an oncological emergency. Many elderly patients cannot tolerate intensive treatment and need individual approaches accounting for a patient's remaining lifetime. The goal of the present study was to develop a survival score for elderly prostate cancer patients with MSCC. Patients and Methods: Nine characteristics were analyzed in 243 patients: age, performance status, interval from prostate cancer diagnosis until MSCC, affected vertebrae, ambulatory status, further bone lesions, visceral metastases, time developing motor deficits, fractionation schedule. Results: Pre-radiotherapy ambulatory status (p<0.001), visceral metastases (p<0.001) and time developing motor deficits (p<0.001) were significant for survival on Cox regression analysis and included in the survival score. Four groups were defined: 9-12, 13-16, 17-19 and 21-23 points. Six-month survival rates were 7%, 28%, 71% and 95%, respectively (p<0.001). Conclusion: The present study identified four groups with different survival probabilities that require treatment strategies with different priorities ranging from symptom control to prolongation of life. Source


Rades D.,University of Lubeck | Conde A.J.,Consorcio Hospital Provincial de Castellon | Garcia R.,Consorcio Hospital Provincial de Castellon | Cacicedo J.,Cruces University Hospital | And 3 more authors.
Radiation Oncology | Year: 2015

Background: Elderly patients become more important in oncology. In this group, personalized treatment approaches taking into account survival prognoses and comorbidities play a major role. Predictive instruments are necessary to estimate the survival of elderly cancer patients. The importance of separate instruments for different tumor entities has been recognized. In this study, an instrument was generated to estimate the survival of elderly patients developing metastatic spinal cord compression (MSCC) from breast cancer. Methods: In 218 elderly patients (age ≥65 years) irradiated for MSCC from breast cancer, nine factors were evaluated for survival: fractionation regimen, age, time from breast cancer diagnosis to RT of MSCC, visceral metastases, other bone metastases, time developing motor deficits, pre-radiotherapy ambulatory status, number of involved vertebrae, and Eastern Cooperative Oncology Group (ECOG) performance score. Factors significantly associated with survival in the Cox regression analysis were included in the prognostic instrument. Scores for each factor were calculated by dividing the 6-months survival rates by 10. The sums of these scores represented the patients' scores. Results: On multivariate analyses, visceral metastases (p < 0.001), time developing motor deficits (p < 0.001), ambulatory status (p < 0.001), number of involved vertebrae (p = 0.032), and ECOG performance score (p < 0.001) were significant and included in the prognostic instrument. Based on the patients' scores, three groups were designed: 18-27 points, 28-39 points and 40-42 points. Six-months survival rates were 4, 62 and 100 %, respectively (p < 0.001). Conclusions: This new instrument contributes to personalized treatment in elderly patients with MSCC from breast cancer by predicting an individual patient's survival prognosis. © 2015 Rades et al. Source


Rades D.,University of Lubeck | Conde-Moreno A.J.,Consorcio Hospital Provincial de Castellon | Segedin B.,Oncology and Radiotherapy Institute | Veninga T.,Dr Bernard Verbeeten Institute | And 2 more authors.
Clinical Lung Cancer | Year: 2015

Background: Elderly patients with lung cancer need personalized treatment in palliative situations such as metastatic epidural spinal cord compression (MESCC). It is crucial to know a patient's survival prognosis to be able to provide optimal and individualized care. Therefore, a prognostic instrument enabling physicians to estimate a patient's survival time is required. We created such an instrument in the present study. Patients and Methods: The data from 201 elderly patients with lung cancer irradiated for MESCC were retrospectively evaluated. The radiation regimen used plus 10 factors were analyzed for associations with survival, including age, gender, histologic features, performance status, interval from lung cancer diagnosis until irradiation of MESCC, interval to developing motor weakness before irradiation, number of affected vertebrae, visceral metastases, other bone metastases, and the ability to walk before irradiation. The factors significant on multivariate analysis were included in the predictive instrument. The factor scores were obtained by dividing the 6-month survival rate by 10, and the patient scores were determined from the sum of the factor scores. Results: Performance status (P = .003), interval to developing motor weakness (P = .006), visceral metastases (P < .001), and the ability to walk (P = .002) were associated with survival. Taking into account the 6-month survival rates of these factors, the patient scores ranged from 5 to 19 points. Thus, 4 groups were designated: those with 5 to 10 points (n = 95), 11 to 13 points (n = 46), 14 to 16 points (n = 33), and 18 to 19 points (n = 27). The corresponding 6-month survival rates were 4%, 26%, 58%, and 81% (P < .001). The corresponding median survival times were 2, 4, 7, and 10 months. Conclusion: This new instrument will enable physicians to predict the survival prognosis of elderly patients with lung cancer-related MESCC, facilitating individualized treatment care. © 2015 Elsevier Inc. Source


Rades D.,University of Lubeck | Conde-Moreno A.J.,Consorcio Hospital Provincial de Castellon | Cacicedo J.,Cruces University Hospital | Veninga T.,Dr Bernard Verbeeten Institute | And 3 more authors.
BMC Cancer | Year: 2016

Background: This study was performed to design a predictive tool that allows the estimation of overall survival (OS) of elderly myeloma patients (aged ≥65years) presenting with myeloma-induced spinal cord compression (SCC). Methods: One-hundred-and-sixteen patients irradiated for motor deficits of the legs due to myeloma-induced spinal cord compression were retrospectively evaluated. Ten characteristics were analyzed for OS including age, interval between myeloma diagnosis and radiotherapy, other osseous myeloma lesions, myeloma type, gender, time developing motor deficits, number of affected vertebrae, ECOG-PS, pre-radiotherapy ambulatory status, and fractionation regimen. Characteristics that achieved significance on multivariate analysis were included in the predictive tool. The score for each characteristic was obtained from the 1-year OS rate divided by 10. The sum of these scores represented the prognostic score for each patient. Results: On multivariate analysis, myeloma type (hazard ratio 3.31; 95%-confidence interval 1.75-6.49; p < 0.001), ECOG-PS (HR 5.33; 95%-CI 2.67-11.11; p < 0.001), ambulatory status (HR 2.71; 95% CI 1.65-4.57; p < 0.001), and age (HR 1.95; 95% CI 1.03-3.78; p = 0.040) were significantly associated with survival. Sum scores ranged from 18 to 32 points. Based on the sum scores, three prognostic groups were designed: 18-19, 21-28 and 29-32 points. The corresponding 1-year survival rates were 0, 43 and 96%, respectively (p < 0.001). Conclusions: This new predictive tool has been specifically designed for elderly myeloma patients with SCC. It allows estimating the survival prognosis of this patient group and supports the treating physicians when looking for the optimal treatment approach for an individual patient. © 2016 Rades et al. Source

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