Page 73 - Predicting survival in patients with spinal bone metastasesL

INTRODUCTION
The treatment of patients with symptomatic spinal bone metastases (SBM) has
made considerable progress over the past two decades. Even though radiotherapy
remains the cornerstone of treatment, surgical interventions are being increasingly
used, ranging from minimally invasive surgery to total en-bloc spondylectomy.
Patients with SBM generally have a short remaining life span, making risk of overtreatment a common concern. Therefore, extent and type of treatment should
not only depend on a patient’s symptoms, but also on expected survival. Several
survival prediction models have been developed to aid in clinical decision making
and whilst they differ in approach, it is accepted that the primary tumor causing
the SBM is the strongest predictor of survival1,2. Patients with symptomatic SBM
from breast cancer tend to live longer than patients with SBM from, for instance,
prostate or lung cancer3,4. This is reflected in all predictive models, where breast
cancer is considered a favorable prognostic factor, as opposed to other primary
cancers5-9. V
Based on estrogen receptor status (ER), progesterone receptor status (PR) and human epidermal growth factor receptor 2 status (HER2), several molecular phenotypes of breast cancer can be distinguished10,11. It has been established that these phenotypes are predictive of survival from the time of diagnosis of the primary tumor12,13, however, it is unclear whether this effect remains when the disease has progressed up to the point of symptomatic SBM. If so, the manner in which the aforementioned predictive models stratify patients based on primary tumors needs to be adjusted, distinguishing between different breast cancer phenotypes.
The aim of the present study was to ascertain whether breast cancer molecular phenotypes are associated with survival of patients presenting with symptomatic SBM and to provide guidelines for improvement of the existing predictive models, if necessary.
BREAST CANCER
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