Serum Lactate Dehydrogenase Contributes to Prognostic Assessment in Patients With Oligometastatic Cancer and Brain Involvement

Reports of Practical Oncology & Radiotherapy

Hintz

Popp

et al. 2020

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Aim: The aim of this study was to characterize the survival results of patients with up to four brain metastases after intense local therapy (primary surgery or stereotactic radiotherapy) if extracranial metastases were absent or limited to one site, e.g. the lungs.Background: Oligometastatic disease has repeatedly been reported to convey a favorable prognosis.Material and Methods: This retrospective study included 198 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy.Information about age, extracranial spread, number of brain metastases, performance status and other variables was collected. Uni-and multivariate tests were performed.Results: Median survival was 16.5 months (single brain metastasis) and 9.8 months (2-4, comparable survival for 2, 3 and 4), respectively (p=0.001). After 5 years, 15 and 2% of the patients were still alive. In patients alive after 2 years, added median survival was 23 months and the probability of being alive 5 years after treatment was 26%. In multivariate analysis, extracranial metastases were not significantly associated with survival, while primary tumor control was.Conclusion: Long-term survival beyond 5 years is possible in a minority of patients with oligometastatic brain disease, in particular those with single brain metastasis. The presence of extracranial metastases to one site should not be regarded a barrier towards maximum brain-directed therapy.

Section: Discussionmentioning

confidence: 99%

Long-term survival results after treatment for oligometastatic brain disease

Reports of Practical Oncology & Radiotherapy

Hintz

Popp

et al. 2020

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“…Statistical analysis. The methods have already been described in our previous study (14). Overall survival (time to death) from the first day of radiotherapy or surgery was calculated employing the Kaplan-Meier method, and different groups were compared using the log-rank test (SPSS 27, IBM Corp., Armonk, NY, USA).…”

Section: Methodsmentioning

confidence: 99%

“…Likely, the score reflects the total tumor burden and associated processes such as inflammation and cachexia (15). Based on previous results with LDH only (14), the hypothesis of the present study was that the LabBM score may improve existing prognostic models, which typically include Karnofsky performance status (KPS) and number of brain metastases (17,18).…”

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confidence: 94%

“…Our group has previously suggested that simple, inexpensive biomarkers based on routine blood tests, e.g. serum lactate dehydrogenase (LDH), may play a role in distinguishing true oligometastatic disease, thus complementing radiological assessment (14). A more comprehensive test panel, the already validated LabBM score (15,16), may further improve the staging process.…”

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confidence: 99%

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Established Serum Biomarkers Are Prognostic Factors in Patients With Oligometastatic Cancer and Brain Involvement

Dalhaug

Mannsåker

2022

In Vivo

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Background/Aim: This study was designed to evaluate the prognostic impact of the previously validated LabBM score (serum lactate dehydrogenase, C-reactive protein, albumin, hemoglobin, platelets) in a new setting, namely patients with a limited number of brain metastases, arbitrarily defined as max. 4 brain lesions, from common tumor types such as lung and breast cancer. A total of 5 metastatic lesions overall were allowed to comply with current definitions of oligometastatic cancer. Patients and Methods: For this retrospective single-institution analysis, 101 patients were identified from a previously described, prospectively maintained database. Results: Twenty-one patients (21%) had extracranial metastases. Non-small cell and small cell lung cancer were the prevailing tumor types (78%). Forty-nine patients (49%) had normal blood test results (LabBM score 0 points). Their median survival (23 months) was significantly longer than that of patients with higher LabBM score. In multivariate analysis, LabBM score, performance status and single brain metastasis were associated with significantly better survival. Limited extracranial metastases did not impair prognosis. Patients with LabBM score 0 had a 5-year survival rate of 27% after surgery (n=24) and 39% after stereotactic radiotherapy (n=13), respectively (p=0.3). Conclusion: Blood biomarkers can be regarded as surrogate of the metastatic burden in the body, which is not always detectable by imaging methods. In contrast to circulating tumor cells and other emerging markers, the LabBM score is inexpensive. Patients with LabBM score >0 had a 2.8-fold increased risk of death. The score might be helpful in predicting survival improvement provided by ablative local treatment of oligometastases.

“…The detection and management of oligometastatic tumors has improved during the last 5-10 years (1,2). Considerable research efforts are undertaken to further improve the outcomes in this biologically distinct subgroup of patients (3)(4)(5)(6)(7). Radiotherapy with ablative doses has gained increasing acceptance in this setting, but palliative radiotherapy continues to represent an important treatment option.…”

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confidence: 99%

Symptom Burden in Patients With Oligometastases at the Start of Palliative Radiotherapy

Kämpe

2020

Anticancer Res

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Background/Aim: Recent studies suggested that patients with oligometastases have a better prognosis compared with those who have widespread dissemination. In both groups, radiotherapy is a commonly applied treatment. Patient-reported symptoms might depend on the burden of disease. Possibly, oligometastatic patients report lower scores for symptoms such as fatigue or reduced appetite, which tend to worsen as the disease progresses to a later stage. Therefore, we analyzed the symptom scores in two groups of patients with or without oligometastatic disease. Patients and Methods:A retrospective study was performed of 83 patients who received palliative, nonablative radiotherapy for distant metastases. The Edmonton Symptom Assessment Scale (ESAS) was employed to assess the pre-radiotherapy symptoms. Results: The oligometastatic group was smaller than anticipated (n=11). The ESAS score differences were not statistically significant. However, oligometastatic patients reported less fatigue, pain and dry mouth (p<0.2). They also had a better performance status. The median survival of oligometastatic patients was longer (8.1 vs. 5.5 months, p=0.17), in the absence of ablative metastases-directed treatment. Conclusion: The oligometastatic state is not a major contributor to the variable patient-reported symptom scores.