Page 15 - Predicting survival in patients with spinal bone metastasesL

GENERAL INTRODUCTION
THESIS OUTLINE I
Given the problems of patient selection described above, the primary aim of this thesis was to provide clinicians an accurate and easy to use risk stratification tool for survival, in order to guide clinical decision making. Chapter II presents a systematic review of risk factors for estimating survival in patients with SBM. Available literature over a period of sixteen years was studied and a level of evidence synthesis was performed to provide an insight into which risk factors are essential for accurate patient selection. Chapter III investigates the effect of risk factors on survival for surgically treated patients and gives an overview of postoperative complications. Chapter IV is the focal point of this thesis and describes a large retrospective series of patients treated with radiotherapy and/ or surgery for symptomatic SBM. In this chapter the clinical model to assess survival is developed and validated on an external dataset. Chapter V provides an adjustment of the prognostic model presented in the previous chapter. It aims to further specify the most important risk factor primary tumor into more accurate subgroups. All available patients with SBM from breast cancer were stratified based on the molecular phenotype, resulting in a more accurate classification for this specific patient category. Chapter VI discusses the performance of the model presented in chapter IV and several other models available in the literature, based on an external dataset. Next to estimation of survival, assessing stability of the spine in metastatic disease is one of the major challenges in patient management. The Spinal Instability Neoplastic Score (SINS) provides a framework to guide clinicians and in Chapter VII the clinical applicability of the SINS is investigated. Finally, a general summary of this thesis is provided in Chapter VIII and conclusions, clinical implications and future perspectives are discussed in Chapter IX.
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