The Relation between Spinal Instability and Response to Palliative Radiotherapy for Symptomatic Spinal Metastases
Notice bibliographique
Résumé
Background and Purpose Up to 70% of cancer patients with terminal illness have bone metastases, with the spinal column being most affected. The standard local treatment for painful spinal metastases is conventional external beam radiotherapy. However, ~30–40% of the patients do not achieve adequate pain relief. It is not well understood why some patients respond and others do not. Considering the limited life expectancy of these patients it is crucial to optimize treatment selection to ensure fast, effective and lasting symptom relief. We hypothesized that pain resulting from mechanical instability of the vertebra responds less well to radiotherapy than pain originating from local tumor effects. The aim of this study was to investigate the relationship between spinal instability, defined by the Spinal Instability Neoplastic Score (SINS), and the response to palliative radiotherapy for symptomatic spinal metastases. Material and Methods A prospective international multicenter observational study of patients who underwent irradiation of symptomatic spinal metastases was performed between January 2013 and December 2014. Patients were excluded if they were diagnosed with multiple myeloma, if they had previous surgery on the same level or if they had substantial neurological deficits (ASIA ≤C). The SINS was calculated by an observer blinded to outcome using the radiotherapy planning computed tomography scans. Pain response was rated using the International Bone Metastases Consensus Working Party Endpoints. The association between SINS and response was estimated by multivariate logistic regression analysis. Results A total of 155 patients were included, 91 male and 64 female (mean age 66 ± 11 years). Thirteen patients (8%) died within four weeks following treatment, 18 (12%) patients were lost to follow-up. Neither median nor mean SINS was significantly different for patients with or without response. In multivariate analysis, the SINS was not significantly associated with response (adjusted odds ratio 0.94; 95% confidence interval 0.81–1.10; p = 0.449). The WHO performance score, however, was related to radiotherapy response. Conclusion No significant relationship was observed between degree of mechanical spinal instability, as reflected by the SINS, and response to radiotherapy. Trying to explain our findings, it can be argued that some components of SINS reflect current mechanical instability while other components are indicative of impending instability. Future studies should aim to optimize the definition of instability to better predict treatment outcome.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».