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The Results of Whole-brain Radiotherapy for Elderly Patients With Brain Metastases from Urinary Bladder Cancer.

ABSTRACT: BACKGROUND/AIM:The number of elderly patients with cancer is growing and requires particular attention. These patients may benefit from personalized treatments. This study aimed to identify prognostic factors of survival for elderly patients (?65 years) irradiated for brain metastases from urinary bladder cancer. PATIENTS AND METHODS:In 29 elderly patients treated with whole-brain radiotherapy (WBRT), seven factors were retrospectively analyzed regarding survival, namely dose-fractionation regimen, age, gender, Karnofsky performance score, number of brain metastases, extra-cranial metastases, and interval between cancer diagnosis and WBRT. RESULTS:For the whole series, survival was 38% at 3 months and 21% at 6 months. Karnofsky performance score ?70% showed a trend for being associated with improved survival when compared to ?60%; survival rates were 50% vs. 29% at 3 months and 33% vs. 12% at 6 months (p=0.18). CONCLUSION:Karnofsky performance score may help estimate the survival of elderly patients irradiated for brain metastases from urinary bladder cancer.

SUBMITTER: Rades D

PROVIDER: S-EPMC7279792 | biostudies-literature | 2020 May-Jun

REPOSITORIES: biostudies-literature

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The Results of Whole-brain Radiotherapy for Elderly Patients With Brain Metastases from Urinary Bladder Cancer.

Rades Dirk D Nguyen Trang T Schild Steven E SE

In vivo (Athens, Greece) 20200501 3

<h4>Background/aim</h4>The number of elderly patients with cancer is growing and requires particular attention. These patients may benefit from personalized treatments. This study aimed to identify prognostic factors of survival for elderly patients (≥65 years) irradiated for brain metastases from urinary bladder cancer.<h4>Patients and methods</h4>In 29 elderly patients treated with whole-brain radiotherapy (WBRT), seven factors were retrospectively analyzed regarding survival, namely dose-frac ...[more]

PMID: 32354924

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Project description:BackgroundBrain metastases (BM) are a common complication in advanced cancer patients, and extremely challenging to treat. Consequently, whole brain radiotherapy (WBRT) remains the standard palliative intervention for patients with BM. The present study set to evaluate the clinical benefits of WBRT by assessing the quality of life (QoL) in WBRT-treated patients with BM, in Nigeria.MethodsThis was a prospective, longitudinal, hospital-based single-centre study. Consecutive sampling methodology was used to recruit 52 patients with BM undergoing WBRT. Patients were followed up on days 7, 30, 90 and 180 after WBRT. The EORTC QLQ-C15-PAL and EORTC QLQ-BN20 were employed to report patients' responses. The likert scale responses were linearly converted into 0 - 100 scores, and the descriptive analysis was conducted using IBM SPSS Statistics 29.0, at 95% confidence interval, using the two-tailed t-test for continuous variables or the chi-square test for categorical values. The overall survival was calculated with the Kaplan Maier method and the difference tested with Log-rank method, considering the interval from the baseline until death or end of the study.ResultsThe study cohort was predominantly females (82.7%), and accordingly, 65.4% of the respondents had a breast primary tumor. A goodness-of-fit test yielded non-significant Chi square Pearson (p = 0.325) and Deviance (p = 1.000) residuals, indicating the best fit. The median overall survival was 180 days (~ 6 months). A total of 20 patients (38%) that survived up to 180 days reported alleviated symptoms and better functioning. A significant improvement in physical functioning (p < 0.001) and emotional functioning (p = 0.031) was reported at 180 days post WBRT, compared to baseline.ConclusionsWBRT is an effective palliative intervention in patients with BM, resulting in improved QoL. More than 50% of patients that survived ~ 3 months reported alleviation of pain, and 38% of patients that survived for ~ 6 months reported a significantly improved functioning. This demonstrated the clinical benefits of WBRT in palliative care and will add to the body of data on the use of WBRT, from Africa.

Project description:The immune modulatory drug chloroquine (CQ) has been demonstrated to enhance survival following radiotherapy in patients with high-grade glioma in a clinical trial, but the efficacy in patients with brain metastases is unknown. We hypothesized that short-course CQ during whole brain radiotherapy (WBRT) would improve response to local therapy in patients with brain metastases. A prospective, single-cohort study was performed combining WBRT with concurrent CQ to assess both the feasibility of and intracranial response to combined therapy in patients with brain metastases. Safety, tolerability and overall survival of this combination was also examined, along with allelic status of IDO2 (indoleamine 2,3-dioxygenase 2), an immune modulatory enzyme inhibited by chloroquine that may affect survival outcomes. CQ therapy (250 mg by mouth daily) was initiated 1 week before WBRT (37.5 Gy in 2.5 Gy daily fractions) in patients with newly diagnosed brain metastases from biopsy-proven, primary lung, breast or ovarian solid tumors (n=20). The primary endpoint was radiologic response 3 months after combined CQ and WBRT therapy. Secondary endpoints included toxicity and overall survival. Patients were stratified by IDO2 allelic status. After a median clinical follow up of 5 months (range, 0.5-31), 16 patients were evaluable for radiologic response which was complete response in two patients, partial response in 13 patients and stable disease in one patient. There were no treatment-related grade≥3 toxicities or treatment interruption due to toxicity. Median and mean overall survival was 5.7 and 8.9 months, respectively (range, 0.8-31). A trend toward increased overall survival was observed in patients with wild-type IDO2 compared to patients with heterozygous or homozygous configurations that ablate IDO2 enzyme activity (10.4 mos vs. 4.1 mos.; p=0.07). WBRT with concurrent, short-course CQ is well tolerated in patients with brain metastases. The high intracranial disease control rate warrants additional study.

Dataset Information

The Results of Whole-brain Radiotherapy for Elderly Patients With Brain Metastases from Urinary Bladder Cancer.

Publications

The Results of Whole-brain Radiotherapy for Elderly Patients With Brain Metastases from Urinary Bladder Cancer.

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