scholarly journals Prognostic value of a patient-reported functional score versus physicianreported Karnofsky Performance Status Score in brain metastases

2017 ◽  
Vol 11 ◽  
Author(s):  
Jai Prakash Agarwal ◽  
Santam Chakraborty ◽  
Sarbani Ghosh Laskar ◽  
Naveen Mummudi ◽  
Vijay M Patil ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Prognostic Value ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Functional Score ◽  
Karnofsky Performance Status Score ◽  
Status Score ◽  
Patient Reported ◽  
Performance Status Score

scholarly journals Is Function-Based Resection Using Intraoperative Awake Brain Mapping Feasible and Safe for Solitary Brain Metastases Within Eloquent Areas?

2021 ◽  
Author(s):  
Jean-Baptiste Pelletier ◽  
Alessandro Moiraghi ◽  
Marc Zanello ◽  
Alexandre Roux ◽  
Sophie Peeters ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Solitary Brain Metastasis ◽  
Neurological Condition ◽  
Eloquent Areas ◽  
Karnofsky Performance Status Score ◽  
Status Score ◽  
Performance Status Score

Abstract ObjectiveTo assess feasibility and safety of function-based resection under awake conditions for solitary brain metastasis patients.MethodsRetrospective, observational, single-institution case-control study (2014-2019). Inclusion criteria: adult patients, solitary brain metastasis, supratentorial location within eloquent areas, function-based awake resection. Case matching (1:1) criteria between metastasis group and control group (high-grade gliomas): sex, tumor location, tumor volume, preoperative Karnofsky Performance Status score, age, educational level.ResultsTwenty patients were included. Intraoperatively, all patients were cooperative, no obstacles precluded procedure from being performed. A positive functional mapping was achieved at both cortical and subcortical levels, allowing for a function-based resection in all patients. The case-matched analysis showed that intraoperative and postoperative events were similar, except for a shorter duration of the surgery (p<0.001) and of the awake phase (p<0.001) in the metastasis group. A total resection was performed in 18 cases (90%, including 10 supramarginal resections), and a partial resection was performed in two cases (10%). At three months postoperative months, none of the patients had worsening of their neurological condition or uncontrolled seizures, three patients had an improvement in their seizure control, and seven patients had a Karnofsky Performance Status score increase ≥10 points.ConclusionsFunction-based resection under awake conditions preserving the brain connectivity is feasible and safe in the specific population of solitary brain metastasis patients and allows for high resection rates within eloquent brain areas while preserving the overall and neurological condition of the patients. Awake craniotomy should be considered to optimize outcomes in brain metastases in eloquent areas.

Radiosurgery for parasagittal and parafalcine meningiomas

2013 ◽  
Vol 119 (4) ◽  
pp. 871-877 ◽  
Author(s):  
Dale Ding ◽  
Zhiyuan Xu ◽  
Ian T. McNeill ◽  
Chun-Po Yen ◽  
Jason P. Sheehan
Keyword(s):  
Cox Regression ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Control ◽  
Who Grade ◽  
Tumor Control Rate ◽  
Karnofsky Performance Status Score ◽  
Status Score ◽  
Performance Status Score

Object Parasagittal and parafalcine (PSPF) meningiomas represent the second most common location for intracranial meningiomas. Involvement of the superior sagittal sinus or deep draining veins may prevent gross-total resection of these tumors without significant morbidity. The authors review their results for treatment of PSPF meningiomas with radiosurgery. Methods The authors retrospectively reviewed the institutional review board–approved University of Virginia Gamma Knife database and identified 65 patients with 90 WHO Grade I parasagittal (59%) and parafalcine (41%) meningiomas who had a mean MRI follow-up of 56.6 months. The patients' mean age was 57 years, the median preradiosurgery Karnofsky Performance Status score was 80, and the median initial tumor and treatment volumes were 3 and 3.7 cm3, respectively. The median prescription dose was 15 Gy, isodose line was 40%, and the number of isocenters was 5. Kaplan-Meier analysis was used to determine progression-free survival (PFS). Univariate and multivariate Cox regression analyses were used to identify factors associated with PFS. Results The median overall PFS was 75.6 months. The actuarial tumor control rate was 85% at 3 years and 70% at 5 years. Parasagittal location, no prior resection, and younger age were found to be independent predictors of tumor PFS. For the 49 patients with clinical follow-up (mean 70.8 months), the median postradiosurgery Karnofsky Performance Status score was 90. Symptomatic postradiosurgery peritumoral edema was observed in 4 patients (8.2%); this group comprised 3 patients (6.1%) with temporary and 1 patient (2%) with permanent clinical sequelae. Two patients (4.1%) died of tumor progression. Conclusions Radiosurgery offers a minimally invasive treatment option for PSPF meningiomas, with a good tumor control rate and an acceptable complication rate comparable to most surgical series.

scholarly journals Clinical Efficacy of HiPorfin Photodynamic Therapy for Advanced Obstructive Esophageal Cancer

2020 ◽  
Vol 19 ◽  
pp. 153303382093033
Author(s):  
Ruifang Zeng ◽  
Chen Liu ◽  
Libo Li ◽  
Xiaojun Cai ◽  
Run Chen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Photodynamic Therapy ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Advanced Esophageal Cancer ◽  
Karnofsky Performance Status Score ◽  
Status Score ◽  
Performance Status Score

Objective: To explore the clinical efficacy of HiPorfin photodynamic therapy for advanced esophageal cancer and evaluate its impact on survival. Methods: Retrospective analysis of 32 patients with advanced obstructive esophageal cancer at our institution from September 2013 to December 2016. HiPorfin was infused as the photosensitizer at a dose of 5 mg/kg, and after 48 hours, 630-nm laser irradiation was subsequently performed through an optical fiber that passed through the biopsy channel of a flexible endoscope. Results: The effectiveness rate was 78.1% (25/32), and the significant efficacy rate was 56.3% (18/32). The dysphagia score decreased from 3.43 ± 0.73 to 1.79 ± 0.53 ( P < .05). There was no grade 3 or more toxicity. The median overall survival was estimated to be 16 months. Univariate analysis showed higher overall survival with a Karnofsky Performance Status score ≥80 compared with a Karnofsky Performance Status score <80 (hazard ratio: 2.626; 95% CI: 1.091-6.322; P = .024). Overall survival was higher in patients who had received radiation therapy than in patients who did not receive radiation therapy (hazard ratio: 3.574; 95% CI: 1.501-8.510; P = .002). Conclusion: Photodynamic therapy is an effective method for advanced esophageal cancer. The side effects are mild, and the short-term effect is good, especially in the relief of dysphagia. Photodynamic therapy can prolong the survival of patients with advanced esophageal cancer, and the Karnofsky Performance Status score and previous radiation therapy have a significant effect on the overall survival.

Timing of Adjuvant Radiotherapy in Glioblastoma Patients

Neurosurgery ◽  
2015 ◽  
Vol 78 (5) ◽  
pp. 676-682 ◽  
Author(s):  
Tony J. C. Wang ◽  
Ashish Jani ◽  
Juan P. Estrada ◽  
Timothy H. Ung ◽  
Daniel S. Chow ◽  
...  
Keyword(s):  
Cox Regression ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Recursive Partitioning ◽  
Recursive Partitioning Analysis ◽  
Adjuvant Radiation ◽  
Cox Regression Analysis ◽  
Karnofsky Performance Status Score ◽  
Status Score ◽  
Performance Status Score

Abstract BACKGROUND: The standard of care for patients with newly diagnosed glioblastoma (GBM) is maximal safe resection followed by adjuvant radiation therapy (RT) and temozolomide (TMZ). OBJECTIVE: To investigate whether the timing of adjuvant RT after surgery affected outcome in patients with GBM. METHODS: We retrospectively reviewed all patients with a diagnosis of GBM at our institution. A total of 447 patients were included in our analysis. Patients were divided into 3 equal groups based on the interval between surgery and RT. The primary outcome was overall survival (OS). RESULTS: Patients who began RT less than 21 days after surgery tended to be older, have a lower a Karnofsky Performance Status score, and higher recursive partitioning analysis class. These patients were more likely to have undergone biopsy only and received 3-dimensional conformal RT or 2-dimensional RT. The median OS for patients who started RT less than 21 days after surgery, between 21 and 32 days after surgery, and more than 32 days after surgery was 374, 465, and 478 days, respectively (P = .004). On multivariate Cox regression analysis, Karnofsky Performance Status score lower than 70, undergoing biopsy only, recursive partitioning analysis classes IV and V/VI, use of less than 36 Gy RT, and lack of TMZ chemotherapy were predictors of worse OS. The interval between surgery and RT was not significantly associated with OS on multivariate analysis. CONCLUSION: Patients who begin RT less than 21 days after surgery tend to have worse prognostic factors than those who begin RT later. When accounting for significant covariates, the effect of timing between surgery and RT is not significant.

scholarly journals Results of the NeuroBlate System first-in-humans Phase I clinical trial for recurrent glioblastoma

2013 ◽  
Vol 118 (6) ◽  
pp. 1202-1219 ◽  
Author(s):  
Andrew E. Sloan ◽  
Manmeet S. Ahluwalia ◽  
Jose Valerio-Pascua ◽  
Sunil Manjila ◽  
Mark G. Torchia ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Phase I ◽  
Dose Escalation ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Recurrent Glioblastoma ◽  
Thermal Therapy ◽  
Laser Interstitial Thermal Therapy ◽  
Karnofsky Performance Status Score ◽  
Performance Status Score

Object Laser interstitial thermal therapy has been used as an ablative treatment for glioma; however, its development was limited due to technical issues. The NeuroBlate System incorporates several technological advances to overcome these drawbacks. The authors report a Phase I, thermal dose–escalation trial assessing the safety and efficacy of NeuroBlate in recurrent glioblastoma multiforme (rGBM). Methods Adults with suspected supratentorial rGBM of 15- to 40-mm dimension and a Karnofsky Performance Status score of ≥ 60 were eligible. After confirmatory biopsy, treatment was delivered using a rigid, gas-cooled, side-firing laser probe. Treatment was monitored using real-time MRI thermometry, and proprietary software providing predictive thermal damage feedback was used by the surgeon, along with control of probe rotation and depth, to tailor tissue coagulation. An external data safety monitoring board determined if toxicity at lower levels justified dose escalation. Results Ten patients were treated at the Case Comprehensive Cancer Center (Cleveland Clinic and University Hospitals–Case Medical Center). Their average age was 55 years (range 34–69 years) and the median preoperative Karnofsky Performance Status score was 80 (range 70–90). The mean tumor volume was 6.8 ± 5 cm3 (range 2.6–19 cm3), the percentage of tumor treated was 78% ± 12% (range 57%–90%), and the conformality index was 1.21 ± 0.33 (range 1.00–2.04). Treatment-related necrosis was evident on MRI studies at 24 and 48 hours. The median survival was 316 days (range 62–767 days). Three patients improved neurologically, 6 remained stable, and 1 worsened. Steroid-responsive treatment-related edema occurred in all patients but one. Three had Grade 3 adverse events at the highest dose. Conclusions NeuroBlate represents new technology for delivering laser interstitial thermal therapy, allowing controlled thermal ablation of deep hemispheric rGBM. Clinical trial registration no.: NCT00747253 (ClinicalTrials.gov).

A Comparative Study of Application Effects Between Coordinate Paper Positioning Assisted Probe Navigation and Probe Navigation in Glioma Surgery

2020 ◽  
Vol 10 (8) ◽  
pp. 1869-1874
Author(s):  
Feinan Dong ◽  
Guifen Li ◽  
Manas Panigrahi
Keyword(s):  
Comparative Study ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Test Group ◽  
Resection Rate ◽  
Glioma Surgery ◽  
Group Test ◽  
Karnofsky Performance Status Score ◽  
Navigation Group ◽  
Performance Status Score

Objective: To compare the effect of coordinate paper positioning assisted probe navigation and probe navigation in glioma surgery. Methods: 20 patients with glioma probe navigation coordinate paper positioning assisted probe navigation group (Test group). The patients were treated with probe navigation and coordinate paper positioning assisted probe navigation, respectively. Result: We made a comparison and found in the Test group was significantly reduced and the resection rate of tumors was significantly increased. The KPS (Karnofsky Performance Status) score in the Test group was significantly increased in 1–6 months. Conclusion: Compared with probe navigation, coordinate paper positioning assisted probe navigation is more effective in glioma surgery, which is worthy of clinical promotion.

scholarly journals Cyberknife® hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

2021 ◽  
Author(s):  
Sergej Telentschak ◽  
Daniel Ruess ◽  
Stefan Grau ◽  
Roland Goldbrunner ◽  
Niklas von Spreckelsen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Poor Prognosis ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Salvage Treatment ◽  
Treatment Modalities ◽  
Large Tumor ◽  
Fractionated Radiotherapy ◽  
Hypofractionated Stereotactic Radiosurgery

Abstract Purpose The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature. Methods All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE). Results We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%. Conclusion Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

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