Abstract P5-16-02: Prognostic factors predicting overal survival after radiotherapy for metastatic spinal cord compression in breast cancer patients treated in the Brazilian public health system
Authors: Reinert Tomas , Zylberberg Ricardo , Lima Frederico MT , Pinto Christiane S , Boukai Alexandre 
Published: May 2015

Abstract
Objective: To evaluate potential prognostic factors for survival after radiotherapy of metastatic spinal cord compression (MSCC) on breast cancer patients treated at the Brazilian public health system.
Methods and materials: We evaluated 51 consecutive patients treated in a single cancer center between May 2011 and May 2012. The following potential prognostic factors were investigated retrospectively: age, performance status, interval between tumor diagnosis and MSCC, presence of visceral metastases, interval between the development of symptoms and radiotherapy, site of compression and Tokushashi index (prognostic criteria index that divides patients into 3 groups with different life expectancy according to their total number of scoring points).
Tokuhashi Score ParametersGeneral condition (ECOG PS)No. extraspinal bone metastasis fociNo. metastasis in the vertebral bodiesMetastases to the major internal organsPrimary site of cancerSpinal cord palsyAdapted from: Spine 1990; 15: 1110-3.
Results: Patients characteristics are shown in Table 2.
Patients characteristicsAge: median (range)54y (28-79)Interval between BC diagnosis and MSCC: median (range)32mo (0-131).Days of hospitalization: median (range)10 (2-67)Visceral metastases (yes/no)49%/51%Site of compression (cervical/thoracic/lumbar)24%/55%/49%Spinal cord palsy (none/incomplete/complete)31%/47%/21%Tokuhashi score risk (low/intermediate/high)30%/35%/33%
Inpatient mortality was 18%. Among the 16 patients who had non-ambulatory status at admission only 2 (12%) were able to walk after treatment. Overall survival was 13,6 months. Overall survival according to the Tokuhashi index was 1,5mo high risk, 13,6mo intermediate risk and 23,3mo low risk.
The following prognostic factors for inferior OS were identified on univariate analysis: high risk Tokuhashi score - HR 3,7 (p 0,0001); PS4 - HR 3,2 (p 0,0004); Presence of visceral metastasis - HR 4,0 (p 0,0001); interval between symptoms and radiotherapy &gt;14d - HR 2,5 (p 0,01). On multivariate analysis, a high risk Tokuhashi score was statistically associated with inferior survival.
Conclusion: Metastatic spinal cord compression is an oncological emergency associated with significant morbidity and mortality. Life expectancy is a key factor for therapeutic planning. In the limited resource setting of the Brazilian public health system, the validation of prognostic factors is essential to guide the clinician on referring the patient to a tertiary cancer care center or to provide palliative care avoiding burden for debilitated patients resulting from multiple daily trips to the radiation oncology department and painful positioning on the treatment couch. This study validated the Tokuhashi index as a useful prognostic tool in this population.
Citation Format: Tomas Reinert, Ricardo Zylberberg, Frederico MT Lima, Christiane S Pinto, Alexandre Boukai. Prognostic factors predicting overal survival after radiotherapy for metastatic spinal cord compression in breast cancer patients treated in the Brazilian public health system [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-16-02.