Gregory J Kubicek1, Alan Turtz2, Jinyu Xue3, Ashish Patel3, Gregory Richards3, Tamara LaCouture3, Louis Cappelli4, Tim Diestelkamp4, Piya Saraiya5, Anne Bexon2, Nati Lerman6, Howard Warren Goldman2. 1. Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey. Electronic address: kubicek-gregory@cooperhealth.edu. 2. Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey. 3. Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey. 4. Rowan Graduate School, Camden, New Jersey. 5. Department of Diagnostic Radiology, Cooper University Hospital, Camden, New Jersey. 6. Department of Medical Oncology, Cooper University Hospital, Camden, New Jersey.
Abstract
PURPOSE: Patients with poor performance status (PS), usually defined as a Karnofsky Performance Status of 60 or less, were not eligible for randomized stereotactic radiosurgery (SRS) studies, and many guidelines suggest that whole-brain radiation therapy (WBRT) is the most appropriate treatment for poor PS patients. METHODS AND MATERIALS: In this retrospective review of our SRS database, we identified 36 patients with PS of 60 or less treated with SRS for central nervous system (CNS) metastatic disease. PS, as defined by the Karnofsky Performance Status, was 60 (27 patients), 50 (8 patients), or 40 (1 patient). The median number of CNS lesions treated was 3. RESULTS: Median overall survival (OS) was 7.2 months (range, 0.73-25.6 months). Fifteen patients (41%) were alive at 6 months, and 6 patients (16.6%) were alive at 1 year. There was no difference in OS in patients who underwent previous WBRT. There were no local failures or cases of radiation toxicity. Distant CNS failures were seen in 9 patients (25%). CONCLUSIONS: Our patients with poor PS had reasonable median OS and relatively low distant CNS failure rates. Patients in this patient population may be ideal candidates for SRS compared with WBRT given the low incidence of distant failure over their remaining lives and the favorable logistics of single-fraction treatment for these patients with debility and their caregivers.
PURPOSE:Patients with poor performance status (PS), usually defined as a Karnofsky Performance Status of 60 or less, were not eligible for randomized stereotactic radiosurgery (SRS) studies, and many guidelines suggest that whole-brain radiation therapy (WBRT) is the most appropriate treatment for poor PS patients. METHODS AND MATERIALS: In this retrospective review of our SRS database, we identified 36 patients with PS of 60 or less treated with SRS for central nervous system (CNS) metastatic disease. PS, as defined by the Karnofsky Performance Status, was 60 (27 patients), 50 (8 patients), or 40 (1 patient). The median number of CNS lesions treated was 3. RESULTS: Median overall survival (OS) was 7.2 months (range, 0.73-25.6 months). Fifteen patients (41%) were alive at 6 months, and 6 patients (16.6%) were alive at 1 year. There was no difference in OS in patients who underwent previous WBRT. There were no local failures or cases of radiation toxicity. Distant CNS failures were seen in 9 patients (25%). CONCLUSIONS: Our patients with poor PS had reasonable median OS and relatively low distant CNS failure rates. Patients in this patient population may be ideal candidates for SRS compared with WBRT given the low incidence of distant failure over their remaining lives and the favorable logistics of single-fraction treatment for these patients with debility and their caregivers.
Authors: In Bong Ha; Jin Ho Song; Bae Kwon Jeong; Hojin Jeong; Yun Hee Lee; Hoon Sik Choi; Ki Mun Kang Journal: Medicine (Baltimore) Date: 2019-10 Impact factor: 1.889