Radiotherapy for metastatic spinal cord compression; can the Rades score predict survival?

INTRODUCTION: Metastatic spinal cord compression (MSCC) can be debilitating and painful and carries a poor prognosis. There is increasing evidence that MSCC can be treated with single-fraction radiotherapy. The Rades score is designed to assist in identifying better prognosis patients who may benefit from longer radiotherapy courses. This study aims to study patterns of care for MSCC at a single center in New Zealand, and assess the Rades score and other variables as predictors of survival. METHODS: An audit of patients receiving palliative radiotherapy for MSCC at a single center over a 5- year period (2010-2014) was performed. Independent variables and the Rades score were gathered for each patient for statistical analysis to investigate associations between potential prognostic factors, treatments and survival. RESULTS: A total of 83 patients underwent analysis. Median overall survival was 14 weeks. Twenty Gray in five fractions (20 Gy/5) was the most frequently delivered radiotherapy course (89%). The simplified Rades score effectively stratified patients with Group 3 patients having significantly better survival with 40% surviving to 6 months compared to Group 1 and 2. Cancer type, receiving chemotherapy and receiving surgery were also significantly associated with survival. CONCLUSION: Overall survival at our centre is consistent with other published series. The Rades score is valid for predicting more prolonged survival in our population and could be used in selecting patients for longer radiotherapy courses.

High-grade Glioma - A decade of care in Christchurch.

INTRODUCTION: High-grade glioma (HGG) is a devastating illness. Our study aimed to investigate outcomes for patients with HGG treated in Christchurch focussing particularly on those diagnosed with glioblastoma mulitforme (GBM); compare GBM survival with international standards; examine factors associated with better prognosis; and assess the involvement of various allied health disciplines. METHODS: A 10-year retrospective study of patients who were diagnosed and treated for HGG at Christchurch Hospital. Kaplan-Meier method was used to estimate survival. Predefined multivariate analysis was performed to investigate potential prognostic and predictive factors. RESULTS: A total of 363 patients were diagnosed with HGG at a median age of 64 years with a 5-year overall survival of 6.1%. Patients with grade IV tumours had a poorer outcome than grade III patients (P = 0.0002, log-rank test). Eighty-two per cent of patients had a surgical resection or biopsy of the tumour. For those patients with GBM, gross tumour resection followed by radical chemoradiation was associated with better survival compared with needle biopsy (HR = 1.93, P = 0.018); increasing age was negatively associated with survival (HR = 1.02 per additional age year, P = 0.037); however, waiting time between neurosurgery and radiation did not affect survival. Six per cent of patients received formal psychological input. CONCLUSION: Our survival outcomes were comparable with internationally published series. More research is required to improve survival in HGG, including molecular guided treatment, and better define treatment paradigms, such as for the elderly and frail.