Bone metastasesPredictive model for survival in patients having repeat radiation treatment for painful bone metastases
Section snippets
Methods
We employed the database of NCIC Clinical Trials Group Symptom Control.20 trial (SC-20) randomizing patients with painful bone metastases requiring repeat radiation to a single or multiple fractions. The eligible patients were 18 years or older with a proven diagnosis of cancer with radiologically confirmed bone metastases that had previously received radiation. Patients with clinical or radiological evidence of spinal cord compression, a pathological fracture, or an impending fracture that
Results
From the SC.20 dataset of 850 patients, 39 patients with missing data were excluded. The training set was made up of 460 patients and the testing set 351 patients. The training and testing sets were comparable among the baseline factors (Table 1). Only KPS and primary cancer site reached the 5% significance level for prediction of survival (Table 2). The partial scores assigned were KPS (90–100, 0; 70–80, 1; 50–60, 2) and primary cancer site (breast, 0; prostate, 1.3; other, 2.6; lung, 3).
Discussion
The NCIC Clinical Trials Group SC.20 randomized trial shows that repeat radiation therapy benefits in patients with bone metastases irrespective of radiation dose schedules and in those who responded or did not respond to the initial radiation [1]. A secondary analysis confirmed that patients responding to reirradiation experienced better QOL scores and less functional interference associated with pain [2].
The major limitation of the trial is lack of concordance between the intention-to-treat
Conflicts of interest
None.
Acknowledgements
This study was supported by the NCIC CTG’s programmatic grants from the Canadian Cancer Society Research Institute; the RTOG grant U10 CA21661 and CCOP grant U10 CA37422 from the National Cancer Institute in the US. Funding for Australia & New Zealand was from Cancer Council Australia (Grant for International Infrastructure Support) and Royal Adelaide Hospital (Special Purposes Fund Research Grant). The Dutch Cancer Society funded the national data management for Dutch patients (Dutch Cancer
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