open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-09-27
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Baseline Karnofsky performance status is independently predictive of death within 30 days of intracranial radiation therapy completion for metastatic disease

Shearwood McClelland III, Namita Agrawal, May F. Elbanna, Kevin Shiue, Gregory K. Bartlett, Tim Lautenschlaeger, Richard C. Zellars, Gordon A. Watson, Susannah G. Ellsworth
DOI: 10.1016/j.rpor.2020.02.014
·
Rep Pract Oncol Radiother 2020;25(4):698-700.

open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-09-27

Abstract

Introduction

For patients with brain metastases, palliative radiation therapy (RT) has long been a standard of care for improving quality of life and optimizing intracranial disease control. The duration of time between completion of palliative RT and patient death has rarely been evaluated.

Methods

A compilation of two prospective institutional databases encompassing April 2015 through December 2018 was used to identify patients who received palliative intracranial radiation therapy. A multivariate logistic regression model characterized patients adjusting for age, sex, admission status (inpatient versus outpatient), Karnofsky Performance Status (KPS), and radiation therapy indication.

Results

136 consecutive patients received intracranial palliative radiation therapy. Patients with baseline KPS <70 (OR = 2.2; 95%CI = 1.6–3.1; p < 0.0001) were significantly more likely to die within 30 days of treatment. Intracranial palliative radiation therapy was most commonly delivered to provide local control (66% of patients) or alleviate neurologic symptoms (32% of patients), and was most commonly delivered via whole brain radiation therapy in 10 fractions to 30 Gy (38% of patients). Of the 42 patients who died within 30 days of RT, 31 (74%) received at least 10 fractions.

Conclusions

Our findings indicate that baseline KPS <70 is independently predictive of death within 30 days of palliative intracranial RT, and that a large majority of patients who died within 30 days received at least 10 fractions. These results indicate that for poor performance status patients requiring palliative intracranial radiation, hypofractionated RT courses should be strongly considered.

Abstract

Introduction

For patients with brain metastases, palliative radiation therapy (RT) has long been a standard of care for improving quality of life and optimizing intracranial disease control. The duration of time between completion of palliative RT and patient death has rarely been evaluated.

Methods

A compilation of two prospective institutional databases encompassing April 2015 through December 2018 was used to identify patients who received palliative intracranial radiation therapy. A multivariate logistic regression model characterized patients adjusting for age, sex, admission status (inpatient versus outpatient), Karnofsky Performance Status (KPS), and radiation therapy indication.

Results

136 consecutive patients received intracranial palliative radiation therapy. Patients with baseline KPS <70 (OR = 2.2; 95%CI = 1.6–3.1; p < 0.0001) were significantly more likely to die within 30 days of treatment. Intracranial palliative radiation therapy was most commonly delivered to provide local control (66% of patients) or alleviate neurologic symptoms (32% of patients), and was most commonly delivered via whole brain radiation therapy in 10 fractions to 30 Gy (38% of patients). Of the 42 patients who died within 30 days of RT, 31 (74%) received at least 10 fractions.

Conclusions

Our findings indicate that baseline KPS <70 is independently predictive of death within 30 days of palliative intracranial RT, and that a large majority of patients who died within 30 days received at least 10 fractions. These results indicate that for poor performance status patients requiring palliative intracranial radiation, hypofractionated RT courses should be strongly considered.

Get Citation

Keywords

Metastatic brain disease; Radiation therapy; 30-day mortality; Fractionation; Palliative Care; Performance status

About this article
Title

Baseline Karnofsky performance status is independently predictive of death within 30 days of intracranial radiation therapy completion for metastatic disease

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 4 (2020)

Pages

698-700

Published online

2020-07-01

DOI

10.1016/j.rpor.2020.02.014

Bibliographic record

Rep Pract Oncol Radiother 2020;25(4):698-700.

Keywords

Metastatic brain disease
Radiation therapy
30-day mortality
Fractionation
Palliative Care
Performance status

Authors

Shearwood McClelland III
Namita Agrawal
May F. Elbanna
Kevin Shiue
Gregory K. Bartlett
Tim Lautenschlaeger
Richard C. Zellars
Gordon A. Watson
Susannah G. Ellsworth

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