Background The primary outcome of this study is to investigate the association between the cardiopulmonary exercise testing (CPET) variables: anaerobic threshold (AT), peak oxygen uptake (VO 2 peak), peak work rate (WR), ventilatory equivalence of CO 2 (VE/VCO 2 ) at the anaerobic threshold (AT) with frailty, measured by the clinical frailty scale (CFS) in patients planned to undergo major abdominal cancer surgery. The secondary outcome is to compare the CPET variables (VO 2 peak, peak WR, VE/VCO 2 at AT) with frailty measured by the CFS in predicting postoperative surgical morbidity in patients following major abdominal cancer surgery. Methods This study was a single-centre prospective cohort analysis of consecutive adult patients undergoing CPET and CFS scoring as part of their pre-operative work-up for major abdominal cancer surgery. Results A total of n = 317 patients underwent CPET and CFS assessment ahead of planned abdominal oncological surgery. Negative correlations were observed between the CPET variables: AT -0.42 p \ 0.01; VO 2 peak -0.53 p \ 0.01; peak WR -0.54 p \ 0.01 with CFS scores and a positive correlation between CFS scores and VE/VCO 2 0.29 p \ 0.01. Only CFS remained statistically significant in a multivariate model OR 2.11 (1.42-3.15) 95% CI associated with Clavien-Dindo (CD) C 1 defined morbidity including the significant univariate variables (VO 2 peak, peak WR and CFS scores). No variables were associated with CD C 3 morbidity. Conclusions In patients scheduled to have major abdominal cancer surgery there was a weak association between poor performance on CPET and increasing frailty measured by the CFS. The CFS score unlike CPET was associated with all post-operative morbidity, but not major complications alone, in these patients. This suggests that CFS may be used as a less expensive alternative to CPET for predicting any postoperative morbidity in major abdominal cancer surgery.
Background: Breast cancer (BC) is one of the most common malignancies affecting women. Brain metastatses (BM) are frequently seen in BC, and can have devastating consequences with significant associated morbidity and mortality. Whole brain radiotherapy (WBRT) is commonly used to treat BM, with variable use of stereotactic radiotherapy (SRT). This study reports on the outcomes of BC patients with BM who received central nervous system (CNS) radiotherapy over a 17-year period at the Royal Marsden Hospital (RMH). Methods: We included all BC patients who had WBRT with or without SRT for intra-parenchymal BM secondary to BC at RMH between 2000 and 2016 inclusive. Instances of meningeal involvement were excluded from analysis. Data collected included age, histological subtype, tumor grade, stage at original BC presentation, receptor status, date of BM diagnosis, number of metastases, size of largest BM, Eastern Cooperative Oncology Group (ECOG) score, presence of extra-cranial metastases (ECM), neurosurgery (NS) and stereotactic radiotherapy (SRT) details, and date of last follow up or death. Univariate and multivariate analyses were performed to analyze the effect of each variable on overall survival (OS) from date of BM. Results: A total of 426 patients were included with a median age of 54 years at BM diagnosis and a median time to BM from BC diagnosis of 43 months. At diagnosis, 94% had invasive ductal carcinoma (IDC) and 70% had Grade 3 disease. Stage IV disease at original BC presentation was seen in 18% of patients. Estrogen receptor (ER+) was positive in 57% (n = 236), progesterone receptor (PR+) in 44% (n = 147), and HER2 (HER2+) in 44% (n = 166). Twenty-two percent (n = 89) were triple negative (TN). Median number of BM was 4 (range 1 – 205) and 20% (n = 72) of patients had only 1 BM. Average size of the largest lesion was 26 mm (range 1 – 75). The ECOG score was 0 – 1 in 61% of patients. Ten percent of patients (n = 44) underwent SRT and 10% (n = 43) underwent NS. Three hundred and eighty patients had died at the time of analysis. Median OS from date of BM was 6.4 months. On univariate analysis, age < 60 years at BC diagnosis (8.1 vs. 4.0 months, p = 0.0007) and BM diagnosis (8.0 vs. 5.6 months, p = 0.03), ECOG status 0-1 (9.6 vs. 4.0 months, p = <0.0001), ER+ (8.0 vs. 6.0 months, p = 0.0007), PR+ (7.6 vs. 6.9 months, p = 0.04), HER2+ (10.5 vs. 5.6 months, p < 0 .0001), SRT (20.3 vs. 5.9 months, p < 0.0001) and NS (20.3 vs. 6.2 months, p < 0.0001) significantly predicted for improved OS. Triple negative status predicted for worse survival (5.6 months vs. 8.1 months, p < 0.0001). On multivariate analysis, ECOG status, ER+, HER2+, treatment with SRT and NS were independent predictors for OS. Conclusions: This study confirms substantial heterogeneity of prognosis in patients with BM from BC, with significantly improved survival in patients selected for SRT or surgery. Further studies are required to optimize the role of CNS radiotherapy techniques such as SRT and hippocampal sparing WBRT in patients with a favorable prognosis. Citation Format: Kothari G, De Ieso PB, Mohammed K, Ross GM. Outcomes of central nervous system radiotherapy for metastatic breast cancer: The Royal Marsden experience 2000 - 2016 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-06.
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