The Relation between Spinal Instability and Response to Palliative Radiotherapy for Symptomatic Spinal Metastases
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".