Serum lactate dehydrogenase predicts survival in small-cell lung cancer patients with brain metastases that were treated with whole-brain radiotherapy

Abstract

This study aimed to identify factors that predict prognosis after radiotherapy for brain metastases (BMs) from small-cell lung cancer (SCLC). This study retrospectively evaluated 48 consecutive patients who underwent whole-brain radiotherapy (WBRT) for BMs from SCLC between February 2008 and December 2017. WBRT was delivered at a median dose of 30 Gy (range: 30–40 Gy) in 10 fractions (range: 10–16 fractions). Clinical factors were tested for associations with overall survival after WBRT. The median survival and 1-year overall survival rate after WBRT treatment were 232 days and 34.4%, respectively. Univariate analyses revealed that longer survival was associated with Eastern Cooperative Oncology Group performance status of 0–1, asymptomatic BMs, lactate dehydrogenase (LDH) in the normal range, Radiation Therapy Oncology Group–recursive partitioning analysis class 2, and a graded prognostic assessment score of ≥1.5 (P < 0.01, P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). In the multivariate analyses, longer survival was independently associated with asymptomatic BMs [hazard ratio for death (HR), 0.32; 95% confidence interval (CI), 0.12–0.79; P < 0.05] and LDH in the normal range (HR, 0.42; 95% CI, 0.21–0.83; P < 0.05). The presence of symptoms due to BMs and LDH values independently predicted prognosis after WBRT for BMs from SCLC. Elevated LDH may provide valuable information for identifying patients with BMs who could have poor survival outcomes.

Treatment patterns and survival outcomes for small-cell lung cancer patients – a Swedish single center cohort study

“…Our results point toward the importance of an adequate assessment of PS when evaluating treatment options for patients with ED, as a patients with poor PS may not derive meaningful benefit of PDCT [25]. In our analyses, a high LDH level was an independent prognostic factor in ED patients [21,27]. PCI was also associated with a better prognosis in ED patients as reported before [28].…”

“…A log-transformed approach was instead chosen for CRP and LDH since the distribution of these lab values was skewed. These clinical and laboratory characteristics were chosen since they are routinely obtained at Karolinska University Hospital and previously have been shown to be prognostically relevant in SCLC patients [20,21].…”

The usefulness of lactate dehydrogenase measurements in current oncological practice

“…Similar conclusions were reported by Anami et al, who found that elevated lactate dehydrogenase level might serve as a highly valuable marker for identifying patients with brain metastases from small cell lung cancer who could have poor survival outcomes. They also observed that higher LDH levels correlated strongly with shorter survival of patients with small-cell lung cancer (SCLC) [73].…”

External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

“…Fortunately, many patients benefit from these treatments, both in terms of symptom control or prevention, radiological disease control, and overall survival. However, a subset of patients is at risk of early death just few weeks after diagnosis of brain metastases [6][7][8][9]. It is therefore of utmost importance to assess each patient's prognosis at the time of diagnosis of brain metastases, in order to provide guidance and to avoid an DOI: 10.1159/000506954 obvious mismatch between intensity of therapeutic measures and outcome.…”