An easy-to-use scoring system to estimate the survival of patients irradiated for bone metastases from lung cancer

BACKGROUND: The remaining lifespan of patients with metastatic lung cancer should be considered when designing a personalized treatment program. To facilitate the estimation survival in lung cancer patients with bone metastases, a specific scoring system was created. METHODS: One-hundred-and-fifty-three patients receiving fractionated radiotherapy for bone metastases without spinal cord compression from lung cancer were included in this retrospective study. Age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, histology, interval from lung cancer diagnosis until irradiation of bone metastases, visceral metastases, additional bone metastases, type and number of irradiated sites, pathological fracture, upfront surgery and previous systemic treatment were evaluated for potential associations with survival. Those factors that were significant (P<0.05) or showed a trend (P≤0.10) on multivariate analysis were used to create the scoring system. RESULTS: On multivariate analysis, ECOG performance score was significant (risk ratio: 2.77, P<0.001), and age showed a trend (risk ratio: 1.34, P=0.10). The following scoring points were assigned: age ≤65 years =1 point, age ≥66 years =0 points, ECOG performance score of 0–1 =1 point, and ECOG performance score of ≥2 =0 points. Three prognostic groups were obtained: 0 points (n=38), 1 point (n=71) and 2 points (n=44). Six-month survival rates were 21%, 41% and 75%, 12-month survival rates 7%, 27% and 56% (P<0.001). CONCLUSIONS: This scoring system can help estimate the remaining lifespan of lung cancer patients to be irradiated for bone metastases and will contribute to the personalization of their treatment.