Comprehensive summary and retrospective evaluation of prognostic scores for patients with newly diagnosed brain metastases treated with upfront radiosurgery in a modern patient collective

Kraft, Johannes; Timmeren, Janita E. van; Frei, Simon; Mayinger, Michael; Borsky, Kim; Kirchner, Corinna; Stark, L. S.; Tanadini‐Lang, Stephanie; Wolpert, Fabian; Weller, Michael; Woodruff, Henry C.; Gückenberger, Matthias; Andratschke, Nicolaus

doi:10.1016/j.radonc.2022.04.024

Cited by 8 publications

(5 citation statements)

References 59 publications

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“…Just like other models, the LabPS did not assign all patients with very short survival to the most unfavorable prognostic groups. An identical observation was made in the brain metastases study,18 leading us and others8 to conclude that LabPS is not able to outperform all other scores. As suggested by our different Cox regression models, this may be explained by the fact that multiple baseline parameters were confirmed as independent prognostic factors, for example, medications which likely reflect symptom severity.…”

Section: Discussionsupporting

confidence: 61%

“…To optimize resource allocation and individual patients’ benefit from “just-as-much-as-needed” radiotherapy approaches, life expectancy should be estimated 7. As recently pointed out by Kraft et al, 8 who applied a large number of published prognostic scores predicting survival in patients with newly diagnosed brain metastases treated with upfront radiosurgery, the most complex model is not necessarily better than simpler ones. A simple assessment of PS already provided very useful information in their study.…”

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confidence: 99%

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The LabPS score

Nieder¹,

Haukland²,

Mannsåker³

et al. 2023

American Journal of Clinical Oncology

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Objectives: To provide a widely applicable, blood-biomarker-based and performance-status-based prognostic model, which predicts the survival of patients undergoing palliative non-brain radiotherapy. This model has already been examined in a cohort of patients treated for brain metastases and performed well. Methods: This was a retrospective single-institution analysis of 375 patients, managed with non-ablative radiotherapy to extracranial targets, such as bone, lung, or lymph nodes. Survival was stratified by LabPS score, a model including serum hemoglobin, platelets, albumin, C-reactive protein, lactate dehydrogenase, and performance status. Zero, 0.5, or 1 point was assigned and the final point sum calculated. A higher point sum indicates shorter survival. Results: The LabPS score predicted overall survival very well (median 0.6 to 26.5 mo, 3-month rate 0% to 100%, 1-year rate 0% to 89%), P=0.0001. However, the group with the poorest prognosis (4.5 points) was very small. Most patients with comparably short survival or radiotherapy administered in the last month of life had a lower point sum. Additional prognostic factors, such as liver metastases, opioid analgesic use, and/or corticosteroid medication, were identified. Conclusions: If busy clinicians prefer a general prognostic model rather than a panel of separate diagnosis-specific/target-specific scores, they may consider validating the LabPS score in their own practice. In resource-constrained settings, inexpensive standard blood tests may be preferable over imaging-derived prognostic information. Just like other available scores, the LabPS cannot identify all patients with very short survival.

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Section: Discussionsupporting

confidence: 61%

mentioning

confidence: 99%

The LabPS score

Nieder¹,

Haukland²,

Mannsåker³

et al. 2023

American Journal of Clinical Oncology

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“…The number and complexity of prognostic scores for brain metastases is increasing [31]. In the SRS era, our data show that performance status continues to be a simple and effective measure for prognostication (Figure 3).…”

Section: Discussionmentioning

confidence: 81%

Predicting Survival with Brain Metastases in the Stereotactic Radiosurgery Era: are Existing Prognostic Scores Still Relevant? Or Can we do Better?

Fittall,

Brewer,

de Boisanger

et al. 2024

Clinical Oncology

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“…This current study proposes a "combined anti-vascular therapy" approach which signi cantly reduces the median SRS interval to 6 days, effectively managing patient symptoms, enhancing quality of life, and mitigating psychological distress. These outcomes are essential considerations for healthcare providers treating LBM patients [25]. Additionally, the anti-angiogenic properties of bevacizumab allow for a synergistic effect with SRS in anti-tumor therapy [26].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression: a retrospective multicenter study

Zhu,

Zhou,

Chen

et al. 2024

Preprint

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Stereotactic radiosurgery poses a significant risk when treating brain metastases in close proximity to the brainstem. To address this issue, a novel approach known as "combined anti-vascular therapy" has been devised for these metastases. This treatment regimen involves a one-week course of two-staged stereotactic radiosurgery (2-SSRS), supplemented with the administration of the anti-vascular agent bevacizumab during the radiosurgery interval. The objective of this study is to assess the efficacy and safety of a combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression. A retrospective analysis was conducted on patients treated at five gamma knife treatment centers to assess changes in tumor size and peritumoral edema volume. Clinical symptom changes were evaluated using the Headache Scale (VAS), Dizziness Disorder Inventory (DHI), Vomiting Scale (VS), and Glasgow Coma Scale (GCS). The Karnofsky Task Scale (KPS) and Barthel Index (BI) were used to assess overall physical fitness and physical activity rehabilitation. Tumor local control (TLC) and overall survival (OS) rate were also calculated for the patients. Among the 36 patients with brain metastases with brainstem compression, 36 received combined anti-vascular therapy. Both edema volume and tumor volume significantly decreased during the treatment period and post-treatment 3 months (p < 0.01). Clinical symptoms, as indicated by median scores of VAS, DHI, VS, and GCS, showed significant improvement during treatment and at the 3-month follow-up (p < 0.01). Median changes in KPS and BI, reflecting overall physical fitness and physical activity rehabilitation, were also similar and statistically significant (p < 0.01). The patient cohort exhibited a median overall survival of 14.2 months, with corresponding 6-month and 12-month survival rates of 91.7% and 80.0%, respectively. Tumor local control rates at 6 and 12 months were 94.7% and 78.9%, respectively.The combination of anti-vascular therapy with 2-SSRS demonstrates safety and efficacy in treating patients with brain metastases with brainstem compression. This approach rapidly alleviates patient symptoms, effectively manages tumor progression, extends overall survival, and exhibits manageable adverse effects.

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Comprehensive summary and retrospective evaluation of prognostic scores for patients with newly diagnosed brain metastases treated with upfront radiosurgery in a modern patient collective

Cited by 8 publications

References 59 publications

The LabPS score

The LabPS score

Predicting Survival with Brain Metastases in the Stereotactic Radiosurgery Era: are Existing Prognostic Scores Still Relevant? Or Can we do Better?

Efficacy and safety of combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression: a retrospective multicenter study

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