Poor performance status and brain metastases treatment: who may benefit from the stereotactic radiotherapy?

2021 ◽  
Vol 152 (2) ◽  
pp. 383-393
Author(s):  
Katarzyna Holub ◽  
Guillaume Louvel
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiotherapy ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status

Prospective evaluation of the palliative effect of whole-brain radiotherapy in patients with brain metastases and poor performance status

2010 ◽  
Vol 49 (3) ◽  
pp. 382-388 ◽  
Author(s):  
Katarzyna Komosinska ◽  
Lucyna Kepka ◽  
Anna Niwinska ◽  
Lucyna Pietrzak ◽  
Marek Wierzchowski ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Performance Status ◽  
Whole Brain Radiotherapy ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Prospective Evaluation ◽  
Whole Brain ◽  
Brain Radiotherapy

scholarly journals A Review of Stereotactic Radiosurgery in the Management of Brain Metastases

2003 ◽  
Vol 2 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Paul W. Sperduto
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Clinical Judgment ◽  
Randomized Trials ◽  
Performance Status ◽  
Poor Performance ◽  
Mass Effect ◽  
Poor Performance Status ◽  
Whole Brain Radiation ◽  
Brain Radiation

This review addresses the epidemiology, historical reports, current issues, data and controversies involved in the management of brain metastases. The literature regarding surgery, whole brain radiation therapy, stereotactic radiosurgery or some combination of those treatments is discussed as well as issues of cost-effectiveness. Ongoing prospective randomized trials will further elucidate the optimal management for patients with brain metastases. Until those data are available, clinicians are encouraged to apply the existing data reviewed here in conjunction with best clinical judgment. A brief clinical guide is as follows. Patients with a solitary metastasis in an operable location and symptomatic mass effect should undergo surgery. Patients with poor performance status (KPS < 70) or more than three brain metastases should receive WBRT alone. Patients with 1-3 brain metastases and KPS ≥ 70, should receive WBRT + SRS. If the patient refuses WBRT or needs salvage after WBRT, then SRS alone is appropriate. Clinicians should not be too dogmatic and should always apply the best clinical judgment.

scholarly journals P14.35 The modern management of brain metastases

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii74-iii75
Author(s):  
N D Wallace ◽  
P J Kelly
Keyword(s):  
Decision Making ◽  
Brain Metastases ◽  
Performance Status ◽  
Treatment Options ◽  
Poor Performance ◽  
Best Supportive Care ◽  
Poor Performance Status ◽  
Trade Off ◽  
Cns Penetration ◽  
The Impact

Abstract BACKGROUND Technological and clinical advances have improved outcomes for patients with brain metastases. They have also added significantly to the complexity of decision-making in such cases. We set out to review the roles of different treatment options to guide management for patients with newly-diagnosed brain metastases. MATERIAL AND METHODS We undertook a comprehensive literature review to examine all treatment options for brain metastases. We particularly focused on recent advances and where these can be applied to clinical practice.We examined the impact of the improvement of SRS technology from older frame-based setups to modern linear accelerator based treatment with the capacity for fractionated stereotactic radiotherapy (SRT). We identified clinical situations where either SRS or WBRT, or a combination of the two, should be most strongly considered. Several novel targeted systemic therapies cross the blood-brain-barrier so we have explored their outcomes for patients with brain metastases from BRAF-mutated melanoma and EGFR or ALK/ROS1 mutated NSCLC. By examining these techniques in detail, we have formulated an algorithm-based approach which can inform management. RESULTS Surgery is most beneficial in patients with a reasonable prognosis and where other treatment options are unlikely to provide equivalent control. SRS to the surgical cavity can frequently be used alone for post-operative consolidation. SRS and fractionated SRT are valuable treatment options for increasingly large lesions and for increasing numbers of lesions. The choice between SRS and WBRT is, in many cases, a trade-off between the improved intracranial control of WBRT and the more favourable side effect profile of SRS. Upfront therapy with some systemic agents with CNS penetration is an acceptable approach in carefully-selected patients whose outcome is felt to be more related to their extracranial disease. Best supportive care is preferable for many patients with poor performance status and/or short prognosis, although more aggressive measures have a role in the case of symptomatic lesions. CONCLUSION A multidisciplinary approach involving Neurosurgeons, and both Radiation and Medical Oncologists is needed to fully evaluate the options for individual patients. As many of the treatment decisions are a trade-off between quality of life and outcome metrics, shared decision-making with patients is also critical to ensure that patients receive the best treatment for them.

Is stereotactic radiosurgery of brain metastases in patients with poor performance status worthwhile?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 192-192
Author(s):  
Federico Ampil ◽  
Donghyun Kim ◽  
Troy Richards ◽  
Moiz Vora ◽  
Glenn Morris Mills ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Performance Status ◽  
Survival Rates ◽  
Poor Performance ◽  
Tumor Control ◽  
Poor Performance Status ◽  
Survival Group ◽  
Prognostic Utility ◽  
The Mean

192 Background: Performance status is a consistent predictor of outcome in people with advanced disease. Variable prognosis has not led to the exclusion of patients with Karnofsky performance scores of < 70 from treatment of brain metastases (BRM) with stereotactic radiosurgery (SRS). The role of SRS for BRM in individuals with poor performance status (PPS) has not been elucidated to date. To better understand the prognostic utility of SRS in this particular patient cohort, we assessed the longevity periods of our treated PPS subjects with BRM. Methods: A retrospective review of patients with BRM treated by SRS during a 10-year period (2000-2009) identified 22 adult individuals with PPS; PPS was defined by the presence of severe hemiparesis or cerebellar ataxia. The primary endpoint of the analysis was survival because of some limitations in the obtained data. The mean follow-up was 26 months (range: < 1 to 144 months). Results: The mean age was 55.8 years, and the majority of the subjects were female. Most of the patients were younger and diagnosed with solitary brain metastasis. The synchronous primary malignant tumor was not yet under control in a third of the patients, and extracranial metastases were noted in 45% of the subjects. Thirteen people (59%) died within two months after therapy, and nine patients (41%) lived for two years or longer. The overall crude survival rates at 1 year and 5 years were 41% and 18%, respectively. Treatment response information was not available in the short-survival group because of early demise. Intracranial tumor control was achieved in the long-term survivors, considering that BRM progression requiring repeat SRS was not observed in any instance. Characterization of the two groups with different longevities was not possible. Conclusions: Early mortality was not predominant in this limited experience, and the observed prolonged survival suggests that SRS still represents a valuable treatment option for individuals with PPS and BRM.

scholarly journals A Retrospective Analysis of Prognostic Factors Influencing Overall Survival and Choice of Radiotherapy Fractionation in Patients with Bone Metastases Who Received Conventional 2D or 3D Palliative Radiotherapy

2021 ◽  
Vol 28 (5) ◽  
pp. 3876-3890
Author(s):  
Patricia Ignat ◽  
Nicolae Todor ◽  
Radu-Mihai Ignat ◽  
Ofelia Șuteu
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Brain Metastases ◽  
Bone Metastases ◽  
Performance Status ◽  
Spinal Metastases ◽  
Palliative Radiotherapy ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Multiple Bone Metastases

Background. Bone metastases are among the most frequent complications of advanced cancers. Palliative radiotherapy regimens vary from single fraction (SFRT) to multiple fraction (MFRT). Objective: to identify prognostic factors for overall survival (OS) and factors that influence the choice of radiotherapy regimen for bone metastases. Methods. 582 patients with bone metastases irradiated between 1 January 2014–31 December 2017 were analyzed. OS was calculated by Kaplan–Meier method. Cox proportional hazard model was used to identify factors that influenced OS, and the logistic regression model was used to identify potential predictors of radiotherapy regimen. Results. 1-, 2- and 3- year OS were 36%, 23%, and 15%, respectively. Negative prognostic factors associated with OS were multiple bone metastases (HR = 5.4), poor performance status (PS) (HR = 1.5), and brain metastases (HR = 1.37) (p < 0.01). Spinal metastases were associated with the choice of a MFRT (OR = 2.09). A poor PS (OR = 0.55), lung (OR = 0.49), and urologic primaries (OR = 0.33) were more likely to receive SFRT (p < 0.01). The re-irradiation rates were 0.5% after MFRT and 12% after SFRT (p < 0.01). Conclusions. Patients with longer OS (good PS, single bone metastasis, and no brain metastases) can benefit the most from MFRT, which is less likely to require re-irradiation. SFRT remains a valid choice for patients with a more reserved outcome (poor PS, lung or urologic primaries, multiple bone metastases).

scholarly journals Durable Clinical Benefit of Pertuzumab in a Young Patient with BRCA2 Mutation and HER2-Overexpressing Breast Cancer Involving the Brain

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Anna Koumarianou ◽  
Christina Kontopoulou ◽  
Vassilis Kouloulias ◽  
Christina Tsionou
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Performance Status ◽  
Brca2 Mutation ◽  
Supportive Therapy ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Her2 Positive ◽  
The Brain ◽  
Positive Breast Cancer

Patients with HER2-positive breast cancer and brain metastases have limited treatment options, and, as a result of their poor performance status and worse prognosis, they are underrepresented in clinical trials. Not surprisingly, these patients may not be fit enough to receive any active treatment and are offered supportive therapy. BRCA2 mutations are reported to be rarely associated with HER2-overexpressing advanced breast cancer and even more rarely with brain metastases at diagnosis. We report on a BRCA2-positive breast cancer patient with metastatic disease in multiple sites, including the brain, and poor performance status who exhibited an extraordinary clinical and imaging response to the novel anti-HER2 therapy pertuzumab after multiple lines of therapy including anti-HER2 targeting. To our knowledge, the clinicopathologic and therapeutic characteristics of this patient point to a unique case and an urgent need for further investigation of pertuzumab in patients with brain metastases.

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