Entity

Time filter

Source Type

Tilburg, Netherlands

Rades D.,University of Lubeck | Veninga T.,Dr Bernard Verbeeten Institute | Bajrovic A.,University of Hamburg | Karstens J.H.,Leibniz University of Hanover | Schild S.E.,Mayo Medical School
Strahlentherapie und Onkologie | Year: 2013

Purpose: This study aimed to develop and validate a scoring system to identify long-term survivors after conventional radiotherapy (RT) for metastatic spinal cord compression (MSCC). Patients and methods: Data from 1,125 patients who had received long-course RT for MSCC were included in this study. Of these patients, 344 survived for over 12 months and 781 died within a year following RT. Based on differences between the distributions of patient characteristics in the two groups, a scoring system was developed. Scores ranged from 0 to 18 points and 15 points was selected as the cutoff for identifying long-term survivors. Data from the 1,125 long-course RT patients (test group) were compared to data from 773 patients receiving short-course RT (validation group). Results: A score of ≥ 15 points was associated with a 94 % proportion of long-term survivors. The 15-point cutoff resulted in a specificity of 98 % and a positive predictive value of 94 % for identification of long-term surviving patients. The proportions of long-term survivors for each scoring point in the validation group were very similar to those in the test group. Conclusion: This new scoring system enabled identification of long-term survivors after RT for MSCC with very high specificity and positive predictive value. The score proved to be valid and reproducible. © 2013 Urban & Vogel.


Rades D.,University of Lubeck | Rades D.,University of Hamburg | Dziggel L.,University of Lubeck | Nagy V.,Oncology and Radiotherapy Institute | And 5 more authors.
Radiotherapy and Oncology | Year: 2013

Background and purpose Survival scores for patients with brain metastasis exist. However, the treatment regimens used to create these scores were heterogeneous. This study aimed to develop and validate a survival score in homogeneously treated patients. Materials and methods Eight-hundred-and-eighty- two patients receiving 10 × 3 Gy of WBRT alone were randomly assigned to a test group (N = 441) or a validation group (N = 441). In the multivariate analysis of the test group, age, performance status, extracranial metastasis, and systemic treatment prior to WBRT were independent predictors of survival. The score for each factor was determined by dividing the 6-month survival rate (in %) by 10. Scores were summed and total scores ranged from 6 to 19 points. Patients were divided into four prognostic groups. Results The 6-month survival rates were 4% for 6-9 points, 29% for 10-14 points, 62% for 15-17 points, and 93% for 17-18 points (p < 0.001) in the test group. The survival rates were 3%, 28%, 54% and 96%, respectively (p < 0.001) in the validation group. Conclusions Since the 6-month survival rates in the validation group were very similar to the test group, this new score (WBRT-30) appears valid and reproducible. It can help making treatment choices and stratifying patients in future trials. © 2013 Elsevier Ireland Ltd. All rights reserved.


Rades D.,University of Lubeck | Rades D.,University of Hamburg | Evers J.N.,University of Lubeck | Veninga T.,Dr Bernard Verbeeten Institute | And 2 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: Many patients with brain metastases receive whole-brain radiotherapy (WBRT) alone. Using 10 × 3 Gy in 2 weeks is the standard regimen in most centers. Regarding the extraordinarily poor survival prognosis of elderly patients with multiple brain metastases, a shorter WBRT regimen would be preferable. This study compared 10 × 3 Gy with 5 × 4 Gy in elderly patients (≥65 years). Methods and Materials: Data from 455 elderly patients who received WBRT alone for brain metastases were retrospectively analyzed. Survival and local (= intracerebral) control of 293 patients receiving 10 × 3 Gy were compared with 162 patients receiving 5 × 4 Gy. Eight additional potential prognostic factors were investigated including age, gender, Karnofsky performance score (KPS), primary tumor, number of brain metastases, interval from tumor diagnosis to WBRT, extracerebral metastases, and recursive partitioning analysis (RPA) class. Results: The 6-month overall survival rates were 29% after 5 × 4 Gy and 21% after 10 × 3 Gy (p = 0.020). The 6-month local control rates were 12% and 10%, respectively (p = 0.32). On multivariate analysis, improved overall survival was associated with KPS ≥ 70 (p < 0.001), only one to three brain metastases (p = 0.029), no extracerebral metastasis (p = 0.012), and lower RPA class (p < 0.001). Improved local control was associated with KPS ≥ 70 (p < 0.001), breast cancer (p = 0.029), and lower RPA class (p < 0.001). Conclusions: Shorter-course WBRT with 5 × 4 Gy was not inferior to 10 × 3 Gy with respect to overall survival or local control in elderly patients. 5 × 4 Gy appears preferable for the majority of these patients. © 2011 Elsevier Inc.


Rades D.,University of Lubeck | Hornung D.,University of Hamburg | Veninga T.,Dr Bernard Verbeeten Institute | Schild S.E.,Mayo Medical School | Gliemroth J.,University of Lubeck
Cancer | Year: 2012

BACKGROUND: Neurosurgical resection is considered the standard treatment for most patients with a single brain metastasis. However, radiosurgery (RS) is a reasonable alternative. It was demonstrated that whole-brain radiotherapy (WBRT) in addition to RS improves local control of 1-3 brain metastases. Little information is available regarding WBRT in addition to RS for a single lesion. METHODS: Data of 63 patients who received RS alone for a single brain metastasis were retrospectively compared with 39 patients treated with WBRT+RS for local control of the treated metastasis, distant intracerebral control, and survival. Seven additional potential prognostic factors were investigated including age, sex, Karnofsky performance score, tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from tumor diagnosis to irradiation. RESULTS: The 1-year local control rates were 49% after RS and 77% after WBRT+RS (P =.040). The 1-year distant control rates were 70% and 90%, respectively (P =.08). The 1-year survival rates were 57% and 61%, respectively (P =.47). On multivariate analysis, improved local control was associated with WBRT+RS (risk ratio [RR], 1.95; P =.033) and interval from tumor diagnosis to irradiation >15 months (RR, 1.88; P =.042). Improved distant control was almost associated with WBRT+RS (RR, 2.24; P =.05) and age (RR, 2.20; P =.05). Improved survival was associated with KPS 90-100 (RR, 1.73; P =.040), no extracerebral metastases (RR, 1.88; P =.013), RPA class 1 (RR, 2.06; P =.005), and interval from tumor diagnosis to irradiation >15 months (RR, 1.98; P =.009). CONCLUSION: The addition of WBRT to RS was associated with improved local control and distant intracerebral control but not survival. Copyright © 2011 American Cancer Society.


Rades D.,University of Lubeck | Veninga T.,Dr Bernard Verbeeten Institute | Hornung D.,University of Hamburg | Wittkugel O.,University of Lubeck | And 2 more authors.
Cancer | Year: 2012

Background: The current study was conducted to compare neurosurgical resection (NR) followed by whole-brain irradiation (WBI) (NR + WBI) with WBI followed by radiosurgery (WBI + RS) in patients with a single brain metastasis. Methods: The outcome of 41 patients treated with WBI + RS was retrospectively compared with 111 patients who received NR;+ WBI with respect to local control of the treated metastasis and survival. Eleven additional potential prognostic factors were investigated, including WBI schedule, patient age, patient gender, Karnofsky performance score (KPS), primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, interval between the first diagnosis of cancer to the treatment of brain metastasis, metastatic site, maximum diameter of the metastasis, and graded prognostic assessment (GPA) score. Results: The 1-year local control rates were 87% after WBI + RS and 56% after NR + WBI (P =.001). Using the Cox proportional hazards model, the treatment regimen remained significant (risk ratio [RR], 2.46; 95% confidence interval [95% CI], 1.29-5.17 [P =.005]). On the multivariate analysis, local control was also found to be associated with the maximum diameter of the metastasis. The 1-year survival rates were 61% after WBI + RS and 53% after NR + WBI (P =.16). Acute and late toxicities were similar in both groups. On the multivariate analysis, KPS, extracerebral metastases, RPA class, and the GPA score were found to be independent predictors of survival. Conclusions: The use of WBI + RS resulted in significantly better local control of the treated metastasis than NR + WBI. Survival was not found to be significantly different in either group. Because WBI + RS is less invasive than NR + WBI, it appears to be preferable for many patients with a single brain metastasis. These results should be confirmed in a randomized trial. © 2011 American Cancer Society.

Discover hidden collaborations