Stereotactic Radiosurgery Alone for One to Two Brain Metastases from Cancer of Unknown Primary.

BACKGROUND/AIM: The use of stereotactic radiosurgery (SRS) alone has become popular for treating patients with a limited number of brain metastases. In very few patients, the primary tumor leading to cerebral spread is unknown. This study investigated the role of SRS for this rare situation. PATIENTS AND METHODS: Eight patients with 1-2 brain metastases from cancer of unknown primary (CUP) received SRS alone (median dose 20 Gy). Five clinical factors were evaluated for association with local control of the irradiated lesions, freedom from new cerebral lesions and survival. RESULTS: Six-month and 12-month survival rates were 63% and 63%, respectively. Improved survival was associated with male gender and only one cerebral lesion. Local control rates at 6 and 12 months were 100%. Six-month rate of freedom from new cerebral lesions was 86%. CONCLUSION: SRS appeared effective and resulted in promising local control and survival rates in patients with 1-2 brain metastases from CUP.

Predictive Factors and a Survival Score for Patients Irradiated for Metastatic Spinal Cord Compression from Carcinoma of the Salivary Glands.

AIM: To our knowledge, this is the first study focusing on metastatic spinal cord compression (MSCC) from carcinoma of the salivary glands. PATIENTS AND METHODS: Nine patients receiving radiation alone were evaluated for improvement of motor deficits, post-radiation gait function and survival. RESULTS: Of nine characteristics (radiation program, age, sex, additional metastases to bone or to other organs, dynamic of motor deficits, pre-radiation gait function, number of vertebrae affected by MSCC, general condition), strong trends were found for associations between improved motor deficits and their dynamic (p=0.05), post-radiation gait function and pre-treatment ambulatory status (p=0.08) and between survival and additional metastases to other organs (p=0.07), dynamic of motor deficits (p=0.07) and general condition (p=0.07). In addition, a survival score was created. Patients with 2-3 points had a significantly better 6-month survival than those with 0-1 points (100% vs. 0%, p=0.027). CONCLUSION: Characteristics predicting outcomes identified in this study and the new survival score can guide physicians when making treatment decisions.

A matched-pair analysis comparing whole-brain radiotherapy with and without a stereotactic boost for intracerebral control and overall survival in patients with one to three cerebral metastases.

BACKGROUND: Twelve years ago, a randomized trial demonstrated that a radiosurgery boost added to whole-brain radiotherapy (WBRT) improved intracerebral control (IC) in patients with one to three cerebral metastases. Overall survival (OS) was improved only in the subgroup of patients with a single metastasis but not in the entire cohort. The present study compared both regimens in a different scenario outside a randomized trial. METHODS: A total of 252 patients with one to three cerebral metastases were included. Eighty-four patients receiving WBRT plus a planned stereotactic boost and 168 patients receiving WBRT alone were individually matched 1:2 for nine factors including fractionation of WBRT, age, gender, performance score, primary tumor, number of cerebral metastases, extracerebral metastases, recursive partitioning analysis class, and time between cancer diagnosis and WBRT. Each group of three patients was required to match for all nine factors. Both groups were compared for IC and OS. RESULTS: IC rates at 6, 12, 18 and 24 months were 88, 71, 45 and 22% after WBRT plus stereotactic boost vs. 75, 48, 38 and 22% after WBRT alone (p = 0.005). OS rates at 6, 12, 18 and 24 months were 76, 53, 32 and 25% after WBRT plus stereotactic boost and 67, 45, 29 and 20% after WBRT alone (p = 0.10). In patients with a single lesion, OS rates were also not significantly different (p = 0.12). CONCLUSIONS: Similar to the previous randomized trial from 2004, this matched-pair study showed that a stereotactic boost in addition to WBRT significantly improved IC but not OS.

A New Scoring Tool to Assess Overall Survival in Patients With Intracerebral Metastases From Gynecological Cancers.

OBJECTIVE: This study aimed to facilitate individualized treatment strategies for intracerebral metastases from gynecological cancers by creating a specific overall survival (OS) score. METHODS/MATERIALS: Fifty-six patients irradiated for cerebral metastases from gynecological cancers were included. Eleven factors were retrospectively analyzed for OS: age, Eastern Cooperative Oncology Group (ECOG) performance score, cancer type, histology, histologic grading, initial stage, number of lesions, extracerebral metastases, time between cancer diagnosis and brain metastases treatment, recursive partitioning analysis class, and type of treatment. Independent predictors of OS were incorporated in the score (better OS, 1 point; worse OS, 0 points). RESULTS: On Cox proportional hazards analysis, performance score (hazards ratio, 1.98; 95% confidence interval, 1.30-3.23; P = 0.001), no extracerebral metastases (3.34; 1.46-8.96; P = 0.003), and recursive partitioning analysis class 1 (3.27; 1.97-5.65; P < 0.001) were significant. The following points were assigned: ECOG score 1 to 2 = 1 point, ECOG score 3 to 4 = 0 points, no extracerebral metastases = 1 point, extracerebral metastases = 0 points. Sum scores were 0 (n = 32), 1 (n = 15), or 2 points (n = 9). Six-month OS rates were 6%, 67%, and 100%, respectively (P < 0.001). CONCLUSIONS: A predictive tool including 3 groups with significantly different OS probabilities was designed for patients with cerebral metastases from gynecological cancers. This tool will aid in choosing individual treatments.

Clinical Factors Asssociated with Treatment Outcomes following Whole-brain Irradiation in Patients with Prostate Cancer.

BACKGROUND/AIM: Patients with prostate cancer represent a small minority of cancer patients presenting with metastases to the brain. This study investigated the role of whole-brain irradiation (WBI) in this rare group. PATIENTS AND METHODS: Eighteen such patients were included. Clinical factors including fractionation program of WBI, age at WBI, Karnofsky performance score (KPS), number of metastases to the brain, involvement of extracerebral metastatic sites, time from prostate cancer diagnosis to WBI and recursive-partitioning-analysis (RPA) class were investigated regarding local (intracerebral) control and survival. RESULTS: On multivariate evaluation, longer time from prostate cancer diagnosis to WBI showed a trend towards improved local control (hazard ratio 2.77, p=0.098). Better KPS (hazard ratio 5.64, p=0.021) and longer time from prostate cancer diagnosis to WBI (hazard ratio 5.64, p=0.013) were significantly associated with better survival. CONCLUSION: Two independent predictors of survival were identified and should be considered when designing for personalized treatment regimens and clinical trials.

A matched-pair study comparing whole-brain irradiation alone to radiosurgery or fractionated stereotactic radiotherapy alone in patients irradiated for up to three brain metastases.

BACKGROUND: This matched-pair study was initiated to validate the results of a retrospective study of 186 patients published in 2007 that compared whole-brain irradiation (WBI) alone and radiosurgery (RS) alone for up to three brain metastases. METHODS: One-hundred-fifty-two patients receiving WBI alone for up to three brain metastases were matched with 152 patients treated with RS of fractionated stereotactic radiotherapy (FSRT) alone 1:1 for each of eight factors (age, gender, Eastern Oncology Cooperative Group (ECOG)-performance score, nature of tumor, brain metastases number, extra-cerebral spread, period from cancer detection to irradiation of brain metastases, and recursive partitioning analysis (RPA)-class. Groups were analyzed regarding intracerebral control (IC) and overall survival (OS). RESULTS: On univariate analysis of IC, type of irradiation did not significantly affect outcomes (p = 0.84). On Cox regression, brain metastases number (p < 0.001), nature of tumor (p < 0.001) and period from cancer detection to irradiation of brain metastases (p = 0.013) were significantly associated with IC. On univariate analysis of OS, type of irradiation showed no significant association with outcomes (p = 0.63). On multivariate analyses, OS was significantly associated with ECOG performance score (p = 0.011), nature of tumor (p = 0.035), brain metastases number (p = 0.048), extra-cerebral spread (p = 0.002) and RPA-class (p < 0.001). CONCLUSION: In this matched-pair study, RS/FSRT alone was not superior to WBI alone regarding IC and OS. These results can be considered a revision of the findings from our retrospective previous study without matched-pair design, where RS alone resulted in significantly better IC than WBI alone on multivariate analysis.

Comparing two lower-dose cisplatin programs for radio-chemotherapy of locally advanced head-and-neck cancers.

Radio-chemotherapy is a common treatment for locally advanced squamous cell head-and-neck cancers (LA-SCCHN). Cisplatin (100 mg/m2) every 3 weeks is very common but associated with considerable toxicity. Therefore, cisplatin programs with lower daily doses were introduced. There is a lack of studies comparing lower-dose programs. In this study, 85 patients receiving radio-chemotherapy with 20 mg/m2 cisplatin on 5 days every 4 weeks (group A) were retrospectively compared to 85 patients receiving radio-chemotherapy with 30-40 mg/m2 cisplatin weekly (group B). Groups were matched for nine factors including age, gender, performance score, tumor site, T-/N-category, surgery, hemoglobin before radio-chemotherapy, and radiation technique. One- and 3-year loco-regional control rates were 83 and 69 % in group A versus 74 and 63 % in group B (p = 0.12). One- and 3-year survival rates were 93 % and 73 % in group A versus 91 and 49 % in group B (p = 0.011). On multivariate analysis, survival was significantly better for group A (HR 1.17; p = 0.002). In groups A and B, 12 and 28 % of patients, respectively, did not receive a cumulative cisplatin dose ≥180 mg/m2 (p = 0.016). Toxicity rates were not significantly different. On subgroup analyses, group A patients had better loco-regional control (p = 0.040) and survival (p = 0.005) than group B patients after definitive radio-chemotherapy. In patients receiving adjuvant radio-chemotherapy, outcomes were not significantly different. Thus, 20 mg/m2 cisplatin on 5 days every 4 weeks resulted in better loco-regional control and survival in patients receiving definitive radio-chemotherapy and may be preferable for these patients. Confirmation of these results in a randomized trial is warranted.

A Scoring Instrument to Predict the Survival Prognoses of Patients with Metastatic Epidural Spinal Cord Compression from Gynecological Malignancies.

AIM: To design a scoring instrument for rating overall survival (OS) of patients with metastatic epidural sinal cord compression (MESCC) from gynecological malignancies. PATIENTS AND METHODS: In 22 patients treated with radiotherapy alone for MESCC from gynecological malignancies, ten factors were analyzed for effects on OS. Factors significantly associated with OS on multivariate analysis were included in a scoring instrument. RESULTS: On multivariate analyses, no visceral metastases (p=0.004) and affection of 1-2 vertebrae (p=0.012) were significant. Scoring points for each factor were 0 or 1, depending on OS rates. After summing, scores of 0 (n=6), 1 (n=9) or 2 points (n=9) were obtained. OS rates were 0%, 78% and 100%, respectively, at 3 months and 0%, 33% and 86%, respectively, at 6 months (p<0.001). CONCLUSION: An instrument was developed for estimating the lifespan of patients with MESCC from gynecological malignancies. This instrument can support physicians when picking an individual treatment.

Comparison of 20×2 Gy and 12×3 Gy for Whole-brain Irradiation of Multiple Brain Metastases from Malignant Melanoma.

BACKGROUND/AIM: Most patients with multiple brain metastases from melanoma receive whole-brain irradiation. In a previous study, doses >30 Gy resulted in better outcomes than 10×3 Gy. However, the optimal dose-fractionation regimen has not yet been defined. This study compared 20×2 Gy over four weeks, which was used in the previous study, to 12×3 Gy over two-and-a-half weeks. PATIENTS AND METHODS: Eleven patients treated with 20×2 Gy for multiple brain metastases were compared to 12 patients treated with 12×3 Gy. RESULTS: Intracerebral control rates at 6 and 12 months were 17% and 0% after 20×2 Gy vs. 42% and 11% after 12×3 Gy (p=0.28). Survival rates at 6 and 12 months were 36% and 9% after 20×2 Gy vs. 50% and 25% after 12×3 Gy (p=0.75). CONCLUSION: The less time-consuming regimen 12x3 Gy appeared not inferior to 20×2 Gy and a reasonable treatment option, particularly for patients with a limited life expectancy.

Local Therapies Can Improve Intracerebral Control in Patients with Cerebral Metastasis from Gynecological Cancers.

BACKGROUND/AIM: Patients with gynecological malignancies account for 2% of patients with cerebral metastases. Many patients receive whole-brain irradiation (WBI) alone. Local therapies (resection, stereotactic radiosurgery (SRS)) are becoming more popular. This study compared intracerebral control after local therapy to WBI alone in patients with gynecological malignancies. PATIENTS AND METHODS: Of 56 patients, 45 received WBI alone, 6 SRS alone and 5 resection plus WBI. Treatment type, age, performance score, cancer site, number of cerebral lesions, metastases outside the brain, recursive partitioning analysis (RPA) class and period from gynecological cancer diagnosis to brain metastasis treatment were evaluated. RESULTS: On univariate analyses, local therapy (p=0.003), single cerebral lesion (p<0.001) and RPA class 1/2 (p=0.027) were positively related to intracerebral control. On Cox regression analysis, local therapy (p=0.013) and RPA class 1/2 (p=0.014) were significant. CONCLUSION: Local therapies led to better intracerebral control than WBI alone and should be considered for brain metastasis from gynecological malignancies whenever reasonable.

Overall Survival After Whole-Brain Radiation Therapy for Intracerebral Metastases from Testicular Cancer.

BACKGROUND/AIM: To identify predictors and develop a score for overall survival of patients with intracerebral metastasis from testicular cancer. PATIENTS AND METHODS: Whole-brain radiation therapy program, age, Karnofsky performance score (KPS), number of intracerebral metastases, number of other metastatic sites and time between testicular cancer diagnosis and radiation therapy were analyzed for their association with overall survival in eight patients. RESULTS: KPS of 80-90% was significantly associated with better overall survival (p=0.006), one or no other metastatic sites showed a trend for a better outcome (p=0.10). The following scores were assigned: KPS 60-70%=0 points, KPS 80-90%=1 point, ≥2 other metastatic sites=0 points, 0-1 other metastatic sites=1 point. Two groups, with 0 and with 1-2 points, were formed. Overall survival rates were 33% vs. 100% at 6 months and 0% vs. 100% at 12 months (p=0.006), respectively. CONCLUSION: A simple instrument enabling physicians to judge the overall survival of patients with intracerebral metastasis from testicular cancer is provided.

Radiochemotherapy for locally advanced squamous cell carcinoma of the head and neck: Higher-dose cisplatin every 3 weeks versus cisplatin/5-fluorouracil every 4 weeks.

Many patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) receive cisplatin-based radiochemotherapy. The optimal regimen is still unclear when considering both efficacy and feasibility. This study compared two regimens for locoregional control (LRC), overall survival (OS), and adverse events. Data of 329 patients with LASCCHN receiving definitive or postoperative radiochemotherapy were retrospectively analyzed. A total of 131 patients received 100 mg/m(2) cisplatin on days 1, 22, and 43 (group A), and 198 patients received 20 mg/m(2) cisplatin plus 600/1000 mg/m(2) 5-FU on days 1-5 and days 29-33 (group B). Radiochemotherapy regimens plus nine factors were compared for LRC and OS, and radiochemotherapy regimens additionally for adverse events. On univariate analysis, chemotherapy type was not associated with LRC (p = 0.36). On multivariate analysis, performance score (p = 0.039), N-category (p = 0.007), histologic grade (p = 0.007), upfront surgery (p = 0.030), and pre-radiochemotherapy hemoglobin levels (p < 0.001) were associated with LRC. On univariate analysis, chemotherapy type had no impact on OS (p = 0.64). On multivariate analysis, performance score (p < 0.001), T-category (p = 0.025), N-category (p < 0.001), histologic grade, and hemoglobin levels (p < 0.001) were associated with OS. Renal failure occurred significantly more often in group A (p = 0.008). Otherwise, adverse events were not significantly different. Thus, both radiochemotherapy regimens appeared similarly effective for LASCCHN. Patients receiving 100 mg/m(2) of cisplatin require close monitoring of their renal function.

Chemoradiation of locally advanced squamous cell carcinoma of the head-and-neck (LASCCHN): Is 20mg/m(2) cisplatin on five days every four weeks an alternative to 100mg/m(2) cisplatin every three weeks?

OBJECTIVES: To compare chemoradiation with 100mg/m(2) cisplatin every three weeks to 20mg/m(2) on five days every four weeks for locally advanced squamous cell carcinoma of the head-and-neck (LASCCHN). MATERIALS AND METHODS: In 230 patients receiving chemoradiation for LASCCHN, 100mg/m(2) cisplatin every three weeks (N=126) and 20mg/m(2) cisplatin on five days every four weeks (N=104) were retrospectively compared. Chemoradiation plus eleven characteristics (T-/N-classification, performance score, gender, age, tumor site, grading, surgery, radiation technique, pre-chemoradiation hemoglobin, cumulative cisplatin dose) were analyzed for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Chemoradiation groups were compared for adverse events. RESULTS: On univariate analyses, chemoradiation had no impact on LRC (p=0.53), MFS (p=0.67) and OS (p=0.14). On multivariate analysis of LRC, T-classification (p=0.045) and hemoglobin (p<0.001) were significant. On multivariate analysis of MFS, performance score (p=0.028) was significant. On multivariate analysis of OS, performance score (p=0.009) and hemoglobin levels (p=0.002) achieved significance. Chemoradiation with 100mg/m(2) cisplatin was associated with more pneumonia/sepsis (p=0.003), grade ⩾2nausea/vomiting (p<0.001), grade ⩾2 nephrotoxicity (p=0.005), grade ⩾2 xerostomia (p=0.002), grade ⩾3 hematotoxicity (p=0.052) and grade ⩾2 ototoxicity (p=0.048). CONCLUDING STATEMENT: 20mg/m(2) cisplatin on five days every four weeks was associated with fewer adverse events than 100mg/m(2) cisplatin every three weeks. 100mg/m(2) cisplatin was not significantly superior to 20mg/m(2) cisplatin regarding LRC, MFS and OS. Given the limitations of a retrospective study, 20mg/m(2) cisplatin appeared preferable. The results should be confirmed in a randomized trial.

Comparison of weekly administration of cisplatin versus three courses of cisplatin 100 mg/m(2) for definitive radiochemotherapy of locally advanced head-and-neck cancers.

BACKGROUND: To compare definitive radiochemotherapy with weekly administration of 30-40 mg/m(2) of cisplatin to 100 mg/m(2) of cisplatin on days 1, 22 and 43 for outcomes and toxicity in patients with squamous cell carcinoma of the head-and-neck. METHODS: Seventy-five patients receiving radiochemotherapy with weekly cisplatin (30-40 mg/m(2)) were compared to 58 patients receiving radiochemotherapy with 100 mg/m(2) cisplatin on days 1, 22 and 43. Radiochemotherapy regimen plus seven characteristics (age, gender, performance score, tumor site, T-/N-category, histologic grading) were evaluated for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Radiochemotherapy groups were compared for toxicity. RESULTS: On multivariate analysis, improved LRC was associated with cisplatin 100 mg/m(2) (hazard ratio [HR] 1.57; p = 0.008) and female gender (HR 4.37; p = 0.003). Radiochemotherapy regimen was not significantly associated with MFS on univariate analysis (p = 0.66). On multivariate analysis, better MFS was associated with ECOG performance score 0-1 (HR 5.63; p < 0.001) and histological grade 1-2 (HR 1.81; p = 0.002). On multivariate analysis, improved OS was associated with cisplatin 100 mg/m(2) (HR 1.33; p = 0.023), ECOG performance score 0-1 (HR 2.15; p = 0.029) and female gender (HR 1.98; p = 0.026). Cisplatin 100 mg/m(2) was associated with higher rates of grade ≥3 hematotoxicity (p = 0.004), grade ≥2 renal failure (p = 0.004) and pneumonia/sepsis (p = 0.033). CONCLUSIONS: Radiochemotherapy with 100 mg/m(2) of cisplatin every 3 weeks resulted in better LRC and OS than weekly doses of 30-40 mg/m(2). Given the limitations of a retrospective study, 100 mg/m(2) of cisplatin appears preferable. Since this regimen was associated with considerable acute toxicity, patients require close monitoring.

A Total Radiation Dose of 70 Gy Is Required After Macroscopically Incomplete Resection of Squamous Cell Carcinoma of the Head and Neck.

AIM: To contribute to the definition of the optimal total radiation dose and to determine the role of concurrent chemotherapy after macroscopically incomplete resection of squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Twenty-six patients treated with postoperative radio(chemo)therapy following macroscopically incomplete resection were evaluated. Total radiation dose (70 Gy vs. 59.4-66 Gy), concurrent chemotherapy (yes vs. no) plus six factors were investigated for locoregional control (LRC) and overall survival (OS). RESULTS: On analyses of LRC, 70 Gy was significantly superior to 59.4-66.0 Gy. Two-year LCR rates were 94% and 25%, respectively (p<0.001). Concurrent chemotherapy significantly improved 2-year LRC (90% vs. 0%, p<0.001). Both 70 Gy (92% vs. 11%, p<0.001) and concurrent chemotherapy (80% vs.0%, p<0.001) also resulted in better OS. CONCLUSION: A total radiation dose of 70 Gy was significantly superior to lower doses regarding both LCR and OS. Concurrent chemotherapy is also very important to achieve optimal outcomes.

Do we need 5-FU in addition to cisplatin for chemoradiation of locally advanced head-and-neck cancer?

OBJECTIVES: To compare chemoradiation with cisplatin alone or cisplatin plus 5-FU for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN). MATERIALS AND METHODS: The outcomes of 142 patients who received chemoradiation with cisplatin alone for locally advanced SCCHN were retrospectively compared to 170 patients who received cisplatin plus 5-fluorouracil (5-FU). The outcomes compared included loco-regional control (LRC), metastases-free survival (MFS), overall survival (OS) and adverse events. RESULTS: Although patients who received cisplatin alone had a significantly worse performance status, 81% of these patients completed planned chemotherapy compared to 73% of patients in the cisplatin plus 5-FU group (p=0.18). Radiotherapy breaks >1week were necessary in 14% and 23% of patients, respectively (p=0.09). The 5-year LRC rates were 69% after cisplatin alone and 68% after cisplatin plus 5-FU (p=0.71). The 5-year MFS rates were 72% and 62%, respectively (p=0.37), and 5-year OS rates were 60% and 45%, respectively (p=0.066). On multivariate analysis, cisplatin alone was significantly associated with improved OS (RR 1.35; 95%-CI 1.09-1.69; p=0.006). Nausea/vomiting, pneumonia/sepsis and late adverse events occurred more common in the cisplatin plus 5-FU group. CONCLUSION: Given the limitations of a retrospective study, chemoradiation with cisplatin alone appeared associated with fewer adverse events and better OS than with cisplatin plus 5-FU in patients with locally advanced SCCHN. Thus, 5-FU in addition to cisplatin may be omitted for these patients. A randomized trial is warranted to confirm these findings.

Forecasting Survival Probabilities After Radiotherapy of Metastatic Epidural Spinal Cord Compression from Colorectal Cancer in the Elderly.

AIM: To develop a tool forecasting survival of elderly patients with metastatic epidural spinal cord compression (MESCC) from colorectal cancer (CRC). PATIENTS AND METHODS: Fifty-seven patients were retrospectively evaluated. Eleven characteristics were investigated for survival. Independent characteristics were used for the tool. Scores were obtained from dividing 6-month survival rates by 10. From summing these points, patient scores were obtained. RESULTS: On survival analysis (Cox regression model), organ metastases (p=0.006), performance status (p<0.001), pre-radiotherapy walking ability (p<0.001) and the dynamic of developing motor weakness (p=0.033) were significant factors affecting survival and were incorporated into the tool. Possible patient scores were 5, 9, 10, 13, 14, 16, 20 or 24 points. Three groups were created with scores of 5-10, 13-16 and 20-24 points, with 6-month survival rates of 4%, 23% and 79%, respectively (p<0.001). CONCLUSION: By applying this tool, it is possible to forecast the survival of elderly patients experiencing MESCC from CRC, which is important for optimal treatment personalization.

Prognostic Factors After Definitive Radio(Chemo)Therapy of Locally Advanced Head and Neck Cancer.

AIM: To identify predictors of locoregional control (LRC) and overall survival (OS) after definitive radio(chemo)therapy for squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Two hundred and seventy-five patients were evaluated; 261 patients received radiochemotherapy with 30-40 mg/m(2) of cisplatin weekly, three courses of cisplatin 100 mg/m(2), two courses of cisplatin 5x20 mg/m(2) or two courses of cisplatin 5×20 mg/m(2)plus 5-fluorouracil. Ten characteristics were analyzed: Pre-radiotherapy hemoglobin, T-/N-category, Karnofsky performance-score (KPS), gender, age, chemotherapy type, tumor site, grading and radiation dose. RESULTS: On multivariate analyses, hemoglobin 12-14 g/dl (p=0.040), lower T-category (p=0.010), lower N-category (p=0.042) and female gender (p=0.006) were predictive of LRC. Hemoglobin >12 g/dl (p=0.020), lower N-category (p<0.001), KPS ≥80 (p<0.001), female gender (p=0.024) and cisplatin 100 mg/m(2) or 5×20 mg/m(2) (p<0.001) were predictors of improved OS. CONCLUSION: Predictors of LRC and OS were identified that can improve personalization of treatment. Since chemotherapy type was associated with OS, studies comparing different regimens are warranted.

Personalized Radiotherapeutic Approaches for Elderly Patients with Epidural Cord Compression from Gastric Cancer.

AIM: To facilitate personalization of radiotherapy (RT) for elderly patients with epidural cord compression (ECC) from gastric cancer. PATIENTS AND METHODS: Several factors were analyzed for survival in 20 elderly patients including age, gender, time period from gastric cancer diagnosis to ECC, metastatic spread, additional osseous lesions, vertebral bodies afflicted by ECC, ambulatory function, dynamic of motor dysfunction, performance status and RT fractionation. RESULTS: Four factors had a significant influence on survival: metastatic spread (p<0.001), ambulatory function (p=0.001), dynamics of motor dysfunction (p=0.002) and performance status (p=0.003). Points were assigned according to factors present for each patient. To avoid confounding variables, performance status was not incorporated into the scoring system. Based on 3-month survival rates, patients were divided into four groups according to the total score: 6, 12-13, 19 and 26 points. Three-month survival rates for these groups were 0%, 50%, 75% and 100%, respectively (p<0.001). CONCLUSION: This score is of great assistance when assigning the appropriate RT approach to an elderly patient with ECC from gastric cancer.

Defining the Optimal Dose of Stereotactic Radiosurgery for Treating Cerebral Metastases in Elderly Patients.

BACKGROUND/AIM: In oncology, elderly people are a separate group of patients requiring special consideration. This applies to the treatment of cerebral metastases as well. The present study focused on elderly patients receiving stereotactic radiosurgery (SRS) for few cerebral lesions. PATIENTS AND METHODS: In 95 patients aged ≥65 years, two SRS doses, 16-18 Gy (n=44) and 20 Gy (n=51), were compared regarding outcomes of SRS. RESULTS: The overall intracerebral control rates at 12 months were 30% after 16-18 Gy and 45% after 20 Gy (p=0.53). Twelve-month rates of freedom from new intracerebral lesions were 41% and 52%, respectively (p=0.63). Twelve-month local control rates of the irradiated lesions were 55% and 81%, respectively (p=0.069). Overall survival rates at 12 months were 29% and 31%, respectively (p=0.67). CONCLUSION: SRS with 16-18 Gy was not significantly inferior to SRS with 20 Gy in elderly patients with few cerebral metastases.