Strahlenther Onkol 2012 · 188:472–477 DOI 10.1007/s00066-012-0086-3 Received: 27 October 2011 Accepted: 25 January 2012 Published online: 25 February 2012 © Springer-Verlag 2012 D. Rades 1 · S. Douglas 1 · T. Veninga 2 · A. Bajrovic 3 · L.J.A. Stalpers 4 · P.J. Hoskin 1 · V. Rudat 6 · S.E. Schild 7 1 Department of Radiation Oncology, University of Lubeck, Lubeck 2 Department of Radiation Oncology, Dr. Bernard Verbeeten Institute Tilburg, Tilburg 3 Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg 4 Department of Radiotherapy, Academic Medical Center Amsterdam, Amsterdam 5 Department of Clinical Oncology, Mount Vernon Centre for Cancer Treatment, Northwood 6 Department of Radiation Oncology, Saad Specialist Hospital Al-Khobar, Al-Khobar 7 Department of Radiation Oncology, Mayo Clinic Scottsdale, AZ, Scottsdale Metastatic spinal cord compression in non-small cell lung cancer patients Prognostic factors in a series of 356 patients Radiotherapy (RT) alone is the most common treatment for metastatic spi- nal cord compression (MSCC) [1, 2, 6, 7, 13, 15]. Patients with non-small cell lung cancer (NSCLC) account for more than 15% of all patients developing MSCC. NSCLC patients have a more unfavor- able prognosis than most other patients with MSCC from other solid tumors [7]. To achieve better personalization of the treatment of MSCC, it is mandatory to identify prognostic factors for particular tumor entities such as NSCLC. Prognos- tic factors help the physician select the treatment for the individual patient. In addition, prognostic factors are impor- tant for stratification in future trials and for the development of prognostic scores. This retrospective international multi- center study can be considered a follow- up study of our series of 252 patients with MSCC from NSCLC published in 2006 [11]. This new study was performed to identify additional independent prog- nostic factors for functional outcome and survival in order to contribute to the per- sonalization of the treatment of MSCC from NSCLC and to the development of scoring systems specifically designed for these patients. Patients and methods The data of 356 patients irradiated for MSCC from NSCLC between 1992 and 2010 were retrospectively reviewed. Cri- teria for inclusion in this study were mo- tor deficits of the lower extremities due to MSCC of the thoracic or the lumbar spine, no prior surgery or RT to the in- volved sites, and confirmation of the di- agnosis of MSCC by spinal MRI (in the majority of patients) or spinal CT. The patients were usually presented to a neu- rosurgeon before RT to discuss the op- tion of decompressive surgery. Dexa- methasone (12–32 mg/day) was admin- istered from the first day of RT for at least one week. The data for the analy- sis were obtained from the patients who were still alive, from their general practi- tioners and/or treating oncologists, and from the patient files. The patient char- acteristics are summarized in . Tab. 1. Each series of the contributing cen- ters represented an unselected group of MSCC patients treated within a specific time period. Irradiation was performed with 6–10 MV photons. Treatment vol- umes encompassed one normal verte- bra above and below the metastatic le- sions. Motor function and ambulatory status were evaluated before RT, and at 1 month, 3 months, and 6 months fol- lowing RT. Motor function was evalu- ated with a 5-point scale: grade 0: nor- mal strength; grade 1: ambulatory with- out aid, grade 2: ambulatory with aid, grade 3: not ambulatory, grade 4: para- plegia [14]. Improvement or deteriora- tion of motor function was defined as a change of at least one point. The following ten potential prognos- tic factors were investigated with respect to post-RT motor function and surviv- al: age (65 vs. ≥ 65 years; median age 64 years), gender, ECOG performance score (ECOG-PS 1–2 vs. 3–4; cut-off ac- cording to the previous study of MSCC [11]), number of involved vertebra (1– 2 vs. ≥ 3; cut-off according to the previ- ous study of MSCC [11]), pre-RT ambu- latory status (not ambulatory vs. ambula- tory), other bone metastases at the time of RT (no vs. yes), visceral metastases at the time of RT (no vs. yes), interval from Original article 472 | Strahlentherapie und Onkologie 6 · 2012