Background/Aim: Very elderly patients may benefit from individualized treatment. A survival score was created for patients aged 80+ receiving radiosurgery or fractionated stereotactic radiotherapy for 1-2 brain metastases. Patients and Methods: Thirteen patients were retrospectively evaluated. Characteristics showing significant associations with survival or trends were used for analysis. Prognostic groups were calculated from scoring points of these characteristics (0=worse, 1=better survival) added for each patient. Results: Survival was significantly associated with performance score (p=0.010). Trends were found for histology (p=0.066) and diameter of lesions (p=0.071). Three groups were created (0, 1-2, 3 points) with 6-month survival rates of 0%, 56%, and 100% (p=0.025). Positive predictive values (PPVs) to predict death ≤6 months were 100% with the new score vs. not available and 50% with previous scores; PPVs regarding survival ≥6 were 100% vs. 75% and 67%. Conclusion: Given its limitations, the score was more precise than previous tools and can serve for orientation in patients aged 80+.Brain metastases occur in 20-40% of adult oncologic patients during the course of their disease (1, 2). A considerable number of these patients receive radiotherapy alone, either as whole-brain irradiation (WBI), as local radiotherapy with single-fraction stereotactic radiosurgery (SRS) or fractionated stereotactic radiation therapy (FSRT), or as a combination of WBI and SRS/FSRT (1-3). Single-fraction SRS is generally limited to lesions with a maximum diameter of 4 cm. Depending on the size of the brain metastases, doses of SRS often range between 15 and 24 Gy (4). Common dose-fractionation regimens of FSRT include 3×9-10 Gy and 5×5-7 Gy. Local radiotherapy is generally used for up to four brain metastases, although it may be applied to selected patients with a greater number of lesions (5). Moreover, since randomized trials have demonstrated that the combination of local radiotherapy and WBI significantly increases the risk of neurocognitive decline, SRS and FSRT are increasingly used without WBI (6, 7).Since the duration of a treatment session increases with the dose per fraction, sessions of SRS and FSRT take longer than sessions of conventional local radiotherapy with doses per fraction of 2-4 Gy. Moreover, the integrated head mask required for SRS and FSRT is much tighter than the mask used for conventional irradiation. Particularly, very elderly, or frail patients may not be able to tolerate the longer lasting treatment sessions of SRS/FSRT and the tight mask and receive shortcourse conventional radiotherapy instead. However, due to technical improvements, SRS and FSRT will likely be used more frequently also for these two groups. Very elderly patients, often defined as 80+, are considered a separate group of patients due to the higher comorbidity index and reduced organ function when compared to other age groups (8-11). These patients would benefit particularly from individualized treatments to avoid over-or undert...

Survival scores facilitate personalized cancer treatment. Due to demographic changes, very elderly patients are more prevalent than in the past. A score was developed in 94 patients aged ≥80 years undergoing whole-brain radiotherapy for brain metastases. Dose fractionation, treatment period, age, sex, performance score (ECOG-PS), tumor type, count of lesions, metastases outside the brain, and interval tumor diagnosis to radiotherapy were retrospectively evaluated. Independent predictors of survival were used for the score. Based on individual scoring points obtained from 3-month survival rates, prognostic groups were designed. Additionally, the score was compared to an existing tool developed in patients ≥65 years. ECOG-PS, count of lesions, and extra-cranial metastases were independent prognostic factors. Three groups were created (7, 10, and 13–16 points) with 3-month survival of 6%, 25%, and 67% (p < 0.001), respectively. Positive predictive values (PPVs) regarding death ≤3 and survival ≥3 months were 94% and 67% (new score) vs. 96% and 48% (existing tool), respectively. PPVs for survival ≥1 and ≥2 months were 88% and 79% vs. 63% and 58%, respectively. Both tools were accurate in predicting death ≤2, ≤3, and ≤6 months. The new score was more precise regarding death ≤1 month and survival (all time periods) and appeared preferable. However, it still needs to be validated.

Background/Aim: Many cancer patients receive radiotherapy, which may cause distress. This pilot study evaluated distress levels before and after radiotherapy to contribute to the design of a prospective trial. Patients and Methods: Two-hundred patients completed distress thermometers before and after radiotherapy. Distress levels ranged from 0 (no distress) to 10 (maximum distress). Five characteristics were retrospectively analyzed regarding changes of distress including age, sex, performance score, tumor type, previous radiotherapy, and treatment intention. Additional analyses were performed for elderly (>65 years) and non-elderly (≤65 years) patients. Results: In all patients and both age groups, median pre-radiotherapy and post-radiotherapy distress levels were 5 (0-10) vs. 4 (0-10) points. Mean changes of distress levels were -0.5 (±2.6) points in all, -0.4 (±2.5) in elderly, and -0.7 (±2.8) in non-elderly patients. Changes were significantly associated with tumor type in all (p=0.049) and elderly (p=0.025) patients. Conclusion: Future studies investigating distress levels in patients receiving radiotherapy should consider age and tumor type. Patients and MethodsA total of 200 patients receiving radiotherapy between November 2021 and April 2022 were included in this pilot study, which was approved by the ethics committee at the University of Lubeck, Germany (reference 2022-412). Characteristics of the patients are summarized in Table I. Patients were asked to complete the distress thermometer of National Comprehensive Cancer Network (1) prior to and directly after completion of their radiotherapy course. Distress levels on this thermometer ranged from 0 (no distress) to 10 (maximum distress) points. In addition, five characteristics were retrospectively analyzed regarding changes of distress during the course of radiotherapy including age (≤65 vs. >65 years), sex (female vs. male), Karnofsky performance score 5561

Survival scores are important for personalized treatment of bone metastases. Elderly patients are considered a separate group. Therefore, a specific score was developed for these patients. Elderly patients (≥65 years) irradiated for bone metastases were randomly assigned to the test (n = 174) or validation (n = 174) cohorts. Thirteen factors were retrospectively analyzed for survival. Factors showing significance (p < 0.05) or a trend (p < 0.06) in the multivariate analysis were used for the score. Based on 6-month survival rates, prognostic groups were formed. The score was compared to an existing tool developed in patients of any age. In the multivariate analysis, performance score, tumor type, and visceral metastases showed significance and gender was a trend. Three groups were designed (17, 18–25 and 27–28 points) with 6-month survival rates of 0%, 51%, and 100%. In the validation cohort, these rates were 9%, 55%, and 86%. Comparisons of prognostic groups between both cohorts did not reveal significant differences. In the test cohort, positive predictive values regarding death ≤6 and survival ≥6 months were 100% with the new score vs. 80% and 88% with the existing tool. The new score was more accurate demonstrating the importance of specific scores for elderly patients.