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PubMed1998

Risk factors for death among cancer patients with fungemia.

In order to identify prognostic factors for death among cancer patients with fungemia, an 18-month survey of fungemia in patients with cancer was undertaken in three hospitals in Rio de Janeiro. For the assessment of risk factors for death, the following variables were analyzed: age; gender; underlying cancer; last treatment for the underlying disease; previous surgery; use of antibiotics, antifungal agents, steroids, or total parenteral nutrition; use of a central venous catheter; chemotherapy; radiotherapy; presence and duration of neutropenia; etiologic agent of the fungemia; treatment of the fungemia; clinical manifestations; and performance status (Karnofsky score) on the day of the positive blood culture. In multivariate analysis, the variables associated with an increased risk for death were older age, persistent neutropenia, and low performance status. Identifying risk factors for death may help to define a group-risk patients for whom new therapeutic options should be tried.

Adult↗
PubMed1989

Hypofractionated radiation therapy and concurrent cisplatin in malignant cerebral gliomas. Rapid palliation in low performance status patients.

Twenty-eight patients with high-grade cerebral gliomas (16 biopsy-proven and 12 diagnosed clinically and by computed tomography scan) were treated with altered fraction radiation and concomitant cisplatin (C-DDP). Twenty cases (Groups IA and IB) whose Karnofsky performance status (KPS) was 60% or less received hypofractionation and C-DDP. All these patients had received high-dose Decadron (Merck Sharp & Dohme, West Point, PA), and their conditions were not improving or progressively deteriorating. The first 11 patients (Group IA) received from 600 cGy twice weekly to 3600 cGy over 3 weeks combined with C-DDP IV at 40 mg/M2 every 2 weeks for two courses. The nine subsequent patients (Group IB) received from 600 cGy weekly to 3600 cGy over 5 to 6 weeks with C-DDP IV at 40 mg/M2 every 1 to 2 weeks for four courses. The target volume in all cases was confined to the tumor as defined on computed tomography (CT) scan with a 2 cm to 3 cm margin. The C-DDP at 40 mg/M2 was administered immediately (within 5 minutes after radiation). Eight cases (Group II) with a KPS of more than 60% were treated with hyperfractionation, i.e., from 200 cGy twice daily to 4800 cGy in just under 3 weeks. The C-DDP was administered every 2 weeks for a total of two courses, as for Group IA. In Group I, 15 of 20 (75%) patients experienced rapid improvement in their performance status, which usually becoming evident within 1 to 2 weeks from the initiation of treatment, and progressed over time. Four patients with a KPS of 10% improved their KPS to over 60%. This regimen was both well tolerated and logistically very convenient both for the patients and attending staff. Follow-up CT scans in three of 16 evaluable patients in the hypofractionated group showed complete tumor resolution. Median survival for Group IA was 7 months, for Group IB was 12 months, and overall was eight months. The Group II median survival was 9 months. This experience suggests that hypofractionated radiation in combination with C-DDP may offer rapid palliation with improvement in functional status in severely compromised patients with malignant glioma.

Adult↗
PubMed1994

Symptom prevalence, characteristics and distress in a cancer population.

Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and outpatients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 evaluable patients was 55.5 years (range 23-86 years); over 60% were women and almost two-thirds had metastatic disease. The Karnofsky Performance Status (KPS) score was < or = 80 in 49.8% and 123 were inpatients at the time of assessment. Across tumour types, 40-80% experienced lack of energy, pain, feeling drowsy, dry mouth, insomnia, or symptoms indicative of psychological distress. Although symptom characteristics were variable, the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing. The mean (+/- SD range) number of symptoms per patient was 11.5 +/- 6.0 (0-25); inpatients had more symptoms than outpatients (13.5 +/- 5.4 vs. 9.7 +/- 6.0, p < 0.002) and those with KPS < or = 80 had more symptoms than those with KPS > 80 (14.8 +/- 5.5 vs. 9.2 +/- 4.9, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Interstitial 125-iodine radiosurgery of low-grade gliomas of the insula of Reil.

Between 1979 and 1991 67 patients with low-grade gliomas of the insula (of Reil) were treated with 125-iodine interstitial radiosurgery. Retrospective analysis with a median follow-up of 55 months demonstrated a 5- and 10-year survival rate of 54% and 47%, respectively, for all low-grade gliomas treated and a 5- and 10-year survival rate of 57% for 49 patients with astrocytomas WHO grade II analysed separately. The median Karnofsky performance status of survivors was 90%. Malignant change was the cause of death in 85%, failure to control tumour growth in the remaining cases. Multivariate analysis with a Cox proportional hazard model identified solely the pre-operative Karnofsky performance score of 70-80 vs. 90% as a prognostic factor for outcome (p = 0.001, risk ratio 3.62), but not age, gender, tumour volume, length of disease before treatment, mode of implantation, or major vs. moderate or no shrinkage of tumour volume after interstitial radiosurgery. Thus, 125-iodine radiosurgery yielded survival rates in these deep-seated insular gliomas comparable to those reported after surgery and radiation therapy of lobar tumours. This was achieved with a low peri-operative mortality and morbidity and at low costs.

Adolescent↗
PubMedDate not supplied

The treatment of metastatic renal cell carcinoma patients with recombinant human gamma interferon.

PURPOSE: Activity has been reported in phase II single-center, open-label studies after administration of low-dose recombinant interferon gamma-1b (rIFN-gamma) to patients with metastatic renal cell carcinoma, with an overall objective response proportion of around 15%. To confirm these data and define the complete response rate, we conducted a multicenter open-label trial in which 204 patients with metastatic renal cell carcinoma were treated with rIFN-gamma. PATIENTS AND METHODS: Two hundred and seven patients (134 males, 73 females, mean age 59) were enrolled, and 202 were evaluable. rIFN-gamma, 60: microgram/m2, was administered subcutaneously once every 7 days until disease progression. RESULTS: There were three (1.5%) complete responses and three (1.5%) partial responses, for an overall response proportion of 3% (95% CI: 1.2%, 6.7%). The median response duration was 13.3 months (range: 2 to 23 months). The median survival was 13.4 months (5.5 months to 29.2 months). Three (1%) deaths were observed during the course of study; they were considered to be related to progressive metastatic renal cell carcinoma. Toxicity was minimal, with 14% of patients experiencing grade 3/4 toxicity. The most frequent adverse events were chills (59%), fever (58%), asthenia (53%), nausea (29%), and headache (18%). Multivariate analysis revealed that younger age, higher performance status, higher hemoglobin, and lower LDH were predictive of survival. DISCUSSION: Recombinant interferon gamma 1b has only minimal efficacy in the treatment of metastatic renal cell carcinoma. Pretreatment variables associated with increased survival were male sex, higher Karnofsky performance status, higher hemoglobin, and low LDH.

Aged↗
PubMed2006

Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90-03.

BACKGROUND: The aim was to evaluate the relationship between nutrition support (NS) on host toxicity and cancer outcome in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing definitive radiotherapy (XRT). METHODS: We performed a secondary analysis of Radiation Therapy Oncology Group (RTOG) 90-03, a prospective randomized trial evaluating four definitive XRT fractionation schedules in patients with locally advanced HNSCC, which prospectively collected data on NS delivered before treatment (BNS), during treatment (TNS), and after definitive XRT. NS data and pretreatment characteristics of the 1073 evaluable patients were analyzed against therapy toxicity and outcome. RESULTS: Patients receiving BNS experienced significantly less weight loss by the end of treatment and less grade 3 to 4 mucositis than patients not receiving BNS. However, patients receiving BNS had a poorer 5-year actuarial locoregional control rate than patients receiving TNS or no NS (29%, 55%, and 57%, respectively, p < .0001) and a poorer 5-year overall survival rate (16%, 36%, and 49%, respectively, p < .0001). Patients receiving BNS were significantly more likely to have a higher T classification, N status, and overall American Joint Committee on Cancer (AJCC) stage and initial presentation with greater pretreatment weight loss, and a poorer Karnofsky Performance Status (KPS) than patients not receiving BNS. After adjusting for the impact of these prognostic factors through a recursive partition analysis, a multivariate analysis with a stratified Cox model found that BNS was still a highly significant independent prognostic factor for increased locoregional failure (hazards ratio [HR], 1.47; 95% confidence interval [CI], 1.21-1.79; p < .0001) and death (HR, 1.41; 95% CI, 1.19-1.67; p < .0001). CONCLUSION: In this study, the largest prospective evaluation of nutrition data in treated patients with cancer, BNS was associated with inferior treatment outcome in the patients with HNSCC undergoing XRT. These results should be considered hypothesis generating and encourage prospective clinical research and identification of the mechanisms underlying this finding.

Adult↗
PubMed2001

Definitive results of a phase II trial of cisplatin, epirubicin, continuous-infusion fluorouracil, and gemcitabine in stage IV pancreatic adenocarcinoma.

PURPOSE: To evaluate the efficacy and toxicity of a cisplatin, epirubicin, gemcitabine, and fluorouracil (PEF-G) schedule on stage IV pancreatic adenocarcinoma. PATIENTS AND METHODS: Patients < or = 70 years, with no prior chemotherapy and with bidimensionally measurable stage IV pancreatic adenocarcinoma, Eastern Cooperative Oncology Group performance status < or = 2, and adequate bone marrow, kidney, and liver function were eligible for this trial. Eligibility criteria for clinical benefit assessment were pain with at least a daily analgesic consumption of two nonsteroidal anti-inflammatory drugs or Karnofsky performance status between 50 and 70. Treatment consisted of 40 mg/m2 each of cisplatin and epirubicin day 1, gemcitabine 600 mg/m2 on days 1 and 8 every 4 weeks, and fluorouracil 200 mg/m2/d as a protracted venous infusion. RESULTS: Between April 1997 and April 1999, 49 patients from a single institution were eligible for the study. Altogether, 203 cycles (median, four cycles) of PEF-G were delivered. The objective response rate was 58% in 43 assessable patients and 51% in the intent-to-treat population. Fourteen patients had stable disease. Grade 3 or 4 World Health Organization neutropenia occurred in 51% of cycles, thrombocytopenia in 28%, anemia in 7%, stomatitis in 5%, and diarrhea, and nausea, and vomiting in 2%. The median duration of response was 8.5 months. The median time to tumor progression was 7.5 months. The median survival was 11 months in the assessable population and 10 months in the intent-to-treat population. Clinical benefit was achieved in 22 (78%) of 28 assessable patients. CONCLUSION: PEF-G is a well-tolerated and safe regimen; it obtained a very high rate of durable responses and deserves further evaluation in a phase III trial.

Adenocarcinoma↗
PubMed1999

Symptom prevalence, characteristics, and distress in AIDS outpatients.

Symptom distress is an important but poorly characterized aspect of quality of life in AIDS patients. To assess and characterize the symptoms and symptom distress associated with AIDS, 504 ambulatory patients with AIDS were evaluated between December, 1992 and December, 1995. The assessment included measures of symptom distress, physical and psychosocial functioning, and demographic and disease-related factors. Patients described symptoms during the previous week using the Memorial Symptom Assessment Scale Short Form (MSAS-SF), a validated measure of physical and psychological symptom distress. The mean age was 38.6 years (range 18-69); 56% were male. African-Americans comprised 40% of the sample, Caucasians 35%, and Hispanics 23%. Ninety-three percent had CD4+ T-cell counts below 500, and 66% had counts below 200; 69% were classified in CDC category C (history of AIDS-defining conditions). Fifty-two percent reported intravenous drug use. Karnofsky performance status was > or = 70 in 80% of the patients. No patients were taking protease inhibitors. The mean (+/- SD) number of symptoms was 16.7 +/- 7.3. The most prevalent symptoms were worrying (86%), fatigue (85%), sadness (82%), and pain (76%). Patients with Karnofsky performance scores < 70 had more symptoms and higher symptom distress scores than patients with scores > or = 70 (21.2 +/- 6.5 vs. 15.6 +/- 7.1 symptoms/patient; 2.3 +/- 0.8 vs. 1.6 +/- 0.8 on the Global Distress Index [GDI] of the MSAS-SF; P < 0.0001 for both). Patients who reported intravenous drug use as an HIV transmission factor reported more symptoms and higher overall and physical symptom distress than those who reported homosexual or heterosexual contact as their transmission factor (17.8 +/- 7.5 vs. 15.4 +/- 6.9 symptoms/patient, P = 0.0002; 1.9 +/- 0.9 vs. 1.6 +/- 0.8 on the MSAS-GDI, P = 0.002). Both the number of symptoms and symptom distress were highly associated with psychological distress and poorer quality of life; for example, r = -0.69 (P < 0.0001) between GDI scores and scores on a validated measure of quality of life. Neither gender nor CD4+ T-cell count was associated with symptom number or distress. Responses from this self-referred sample of AIDS outpatients indicate that AIDS patients experience many distressing physical and psychological symptoms and a high level of distress. Both the number of symptoms and the distress associated with them are associated with a variety of disease-related factors and disturbances in other aspects of quality of life. Symptom assessment provides information that may be valuable in evaluating AIDS treatment regimens and defining strategies to improve quality of life.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Cisplatin-cyclophosphamide-mitomycin combination chemotherapy with supportive care versus supportive care alone for treatment of metastatic non-small-cell lung cancer.

BACKGROUND: Patients with TNM stage IV non-small-cell lung cancer have short survival times. Previous controlled studies comparing chemotherapy and supportive care for the treatment of this type of cancer have not given consistent results, have included patients with different disease stages, and have rarely reported drug dose intensity. PURPOSE: The present trial was designed to assess the safety and the effect on survival of supportive care alone versus chemotherapy with cisplatin, cyclophosphamide, and mitomycin combined with appropriate supportive care in patients with stage IV non-small-cell lung cancer. METHODS: Patients (n = 102) with stage IV non-small-cell lung cancer were randomly assigned to one of two treatment regimens. The combined modality group (52 patients) received supportive care along with cisplatin (75 mg/m2), cyclophosphamide (400 mg/m2), and mitomycin (10 mg/m2) given intravenously at 3-week intervals. The supportive care group (50 patients) received supportive care alone. Randomization was stratified on the basis of histology (squamous versus nonsquamous cell carcinoma), performance status (Karnofsky), and weight loss (during the 6 months preceding randomization). The two groups were well matched for age and sex. Survival analysis was performed after the last patient died. RESULTS: The median number of chemotherapy cycles was 3.5 per patient. Mean weekly delivered doses of drugs were as follows: cisplatin, 22.1 mg/m2; cyclophosphamide, 118 mg/m2; and mitomycin, 2.9 mg/m2. Toxic effects due to chemotherapy were generally mild, but peripheral neuropathy and hematologic and renal toxic effects were observed. In the supportive care group, mean survival was 6.1 months (median, 4.0 months); six patients lived at least 12 months and two lived at least 18 months. In the combined modality group, mean survival was 11.3 months (median, 8.5 months); 20 patients lived at least 12 months, 13 lived at least 18 months, and five lived at least 24 months. Difference in survival was statistically significant (P < .0001). Survival was directly related to initial performance status in both groups (P < .01) and was significantly (P < .01) longer for patients with squamous cell carcinoma than for those with nonsquamous cell carcinoma. CONCLUSIONS: The combination of supportive care and cisplatin-cyclophosphamide-mitomycin therapy offers a survival advantage over supportive care alone in patients with advanced non-small-cell lung cancer. IMPLICATIONS: Metastatic non-small-cell lung cancer, generally considered to be unresponsive or marginally responsive to chemotherapy, can be treated with chemotherapy, with an expectation of prolonging patient survival. Although the results of the present study are encouraging, clinical research should continue to be directed toward developing more effective treatments for this disease.

Adult↗
PubMed1998

Proxy-perceived prior health status and hospital outcome among the critically ill: is there any relationship?

OBJECTIVES: To measure the health status of critically ill patients prior to hospital admission and to study the relationship between prior health status (PHS) and hospital mortality. DESIGN: 523 patients admitted to the intensive care department from October 1994 to June 1995 were included consecutively in the study. Health status 3 months prior to admission was assessed retrospectively by proxies using the EuroQol 5D (EQ-5D) and the Karnofsky Performance Status Scale (KF). Patients were classified into four admission categories: trauma injury, scheduled surgery, unscheduled surgery and other medical conditions. SETTING: Department of Intensive Medicine, University Hospital of Bellvitge, Barcelona, Spain. PATIENTS: 84 trauma injury patients, 239 scheduled surgery patients, 57 unscheduled surgery patients and 143 patients with other medical conditions. INTERVENTIONS: The descriptive system and visual analogue scale (VAS) of the EQ-5D and the K.F. MEASUREMENTS AND MAIN RESULTS: Using proxy responses we found that trauma injury patients had the best PHS and scheduled surgery patients the worst. There were statistically significant differences in mean VAS scores and all EQ-5D dimensions, except self-care, when trauma injury patients or scheduled surgery patients were compared with the other admission categories. No significant differences were found on these variables between unscheduled surgery patients and medical patients. We found no statistically significant differences in PHS health status between patients who died and those who survived, either within each admission category or in the sample as a whole. CONCLUSIONS: The PHS of critically ill patients varied according to admission category. Given the instruments used and population studied, there was no association between PHS and hospital outcome.

Adult↗
PubMed1993

Fluctuations in physical function: adults with non-small cell lung cancer.

Disruptions in physical activities (functional status) were measured over a 1-month period in 24 patients with non-small cell lung cancer with the Karnofsky Performance Status Index and two patient self-report measures. Changes over time were noted for the whole group, and mean scores of the treated subgroup were compared with an untreated cohort. Prior weight loss was significantly associated with baseline functional status. Age was not significantly associated with degree of functional disruption, though 42% of the sample was aged 65 years or older. The greatest disruptions in physical activity were noted in ambulation. A third of the sample had difficulty walking one block or more. Serious fatigue was experienced by 79% of the subjects and 44% had difficulty with household chores. Only 21% were completely satisfied with their level of activity. Pain improved in the treated subjects over time. Despite no significant differences at baseline, untreated subjects had more limitations in physical activities than treated subjects over time. All three instruments were significantly correlated. Careful monitoring of physical difficulties may help nurses focus interventions and decrease the physical distress associated with illness and treatment. In this study, those receiving chemotherapy did not experience significantly greater physical dysfunction. In fact, the untreated patients, who might not receive vigilant nursing assessment, demonstrated greater physical decline.

Activities of Daily Living↗
PubMed1997

Disease-related factors associated with health-related quality of life in people with nonadvanced HIV disease assessed using an Italian version of the MOS-HIV Health Survey.

OBJECTIVE: This study was intended to present evidence for the reliability and validity of an Italian version of the MOS-HIV Health Survey and to identify important disease-related factors associated with health-related quality of life (HRQoL) in people with nonadvanced HIV. DESIGN: In this cross-sectional study, HRQoL was measured using an Italian version of the MOS-HIV Health Survey questionnaire in 213 HIV-infected people without previous opportunistic infections or neoplasms attending an outpatient clinic in a university hospital. Distribution of scores, reliability, and validity were calculated, and presence and frequency of HIV-related symptoms were recorded and transformed into a score. The relation of HRQoL values to sociodemographic, epidemiologic, and clinical data was assessed. RESULTS: The level of internal consistency of the Italian version of the MOS-HIV Health Survey was high (Cronbach's alpha, 0.80-0.93), and items demonstrated acceptable discrimination across scales. At linear regression analysis, all domains of HRQoL correlated with symptom score (r2 range, 0.07-0.41), but only the pain and physical-functioning scores showed a significant correlation with CD4 cell count. A weighted sum of single domains of HRQoL, TOTQoL, is also strongly correlated with symptom score (r2 = 0.57; p < .0001) but not with CD4 cell count (r2 = 0.01; p = .1). Using multivariate analysis, only symptom score (p < .0001) and total number of daily pills (p = .03) showed significant association with HRQoL. The same results were observed when analysis was performed only on people with CD4 levels <200/microl. CONCLUSIONS: This study presents the first evidence for the reliability and validity of a HRQoL instrument in Italian for people with HIV. Results also suggest a strong impact of symptoms on all measured dimensions of health status. The number of pills required to be taken daily is the only other significant factor associated with a lower HRQoL, whereas no relations were found with CD4 cell count or Karnofsky performance status values. To improve HRQoL in persons with nonadvanced HIV disease, symptom control could be a crucial element of medical treatment.

Adult↗
PubMed1998

Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients.

The relationship between weight loss, appetite, the inflammatory response, and quality of life in patients with advanced gastrointestinal cancer was examined. Height, weight, and skinfold anthropometry were measured in 119 patients. Blood was taken for analysis of C-reactive protein and albumin. Appetite, performance status, and quality of life were assessed using EuroQol EQ-5D and EORTC QLQ-C30 questionnaires. Weight loss was > 5% (median 17.1%) of their preillness weight in 97 patients; the remaining 22 patients were weight stable. Anthropometric measurements and circulating albumin concentrations were significantly lower (p < 0.01) and circulating concentrations of C-reactive protein were significantly higher in the weight-losing than in the weight-stable group (p < 0.001). Appetite scores, performance status, and EuroQol EQ-5D and EORTC QLQ-C30 scores were also lower in the weight-losing group (p < 0.01). When the weight-losing cancer patients were divided on the basis of whether they had a marked inflammatory response, albumin concentrations, appetite, and Karnofsky performance status were significantly lower (p < 0.05) in the group with a marked inflammatory response. The results of the present study are consistent with weight loss, reduction of appetite, and an elevated inflammatory response being important related factors in lowering the quality of life of gastrointestinal cancer patients.

Aged↗
PubMed1993

Placebo-blinded study of morphine sulfate sustained-release tablets and immediate-release morphine sulfate solution in outpatients with chronic pain due to advanced cancer.

PURPOSE: This study was conducted to compare the relative analgesic efficacy and safety of an every-4-hour immediate-release oral morphine (IRM) solution with that of an every-12-hour sustained-release oral morphine (SRM) formulation. PATIENTS AND METHODS: This was a double-blind, placebo-blinded, crossover study in 34 adult male and female outpatients with pain due to advanced cancer. Baseline data were collected on day 1. On days 2 and 3, randomly assigned patients received either placebo plus IRM (Roxanol; Roxane Laboratories, Inc, Columbus, OH; 20 mg/mL) at 2, 6, and 10 am, and 2, 6, and 10 pm, or alternatively SRM (Oramorph SR; Roxane Laboratories, Inc; 30 mg) at 10 AM and 10 PM. Patients were then crossed over to the alternate treatment for days 4 through 6. Pain relief was measured using a conventional 100-mm visual analog scale (VAS) and by recording the incidence of breakthrough pain. Information on side effects was obtained from VAS scores for sedation, nausea, anxiety, and depression; by directly questioning the patient as to mental confusion, bowel movements, and laxative use; and from Karnofsky performance status scores. VAS data were analyzed using a linear statistical model. Breakthrough pain data were analyzed using analysis of variance (ANOVA). RESULTS: There were no statistically significant differences between IRM and SRM treatments with respect to VAS pain scores, side effect scores, or incidence of breakthrough pain data. Karnofsky performance scores remained stable for all patients throughout the study. CONCLUSION: It was concluded that every-12-hour administration of SRM and every-4-hour administration of IRM provide similar analgesic effectiveness and side effect profiles in the treatment of chronic pain in cancer patients.

Chemistry, Pharmaceutical↗
PubMedDate not supplied

Prognostic factors in patients with brain metastases.

Management of patients with brain metastases (BrM) has been evolving over time, with a general tendency towards a more aggressive treatment approach. Although whole brain radiotherapy (WBRT) remains the mainstay of treatment for the majority of patients, the indications for stereotactic radiosurgery (SRS) with or without WBRT have been expanding rapidly. In order to select patients who would benefit from the improved intracranial control rates obtained with advanced radiation therapy techniques, knowledge of prognostic factors is essential. Literature findings indicate that performance status, age and systemic tumour activity (extracranial metastases and primary tumour status) are the major determinants of survival for patients with BrM. Based on recursive partitioning analysis (RPA) of these factors, the Radiation Therapy Oncology Group has developed a prognostic classification system for patients with BrM. RPA Class 1 represents the most favourable subset of patients with Karnofsky performance status of > or = 70, age under 65 years, controlled primary tumour and no extracranial metastases. RPA Class 3 patients have KPS < 70, associated with poor median survival rates. RPA Class 2 contains the remainder of patients, a rather heterogeneous subset of patients with intermediate survival rates. This RPA classification system, which has been validated for patients treated with WBRT, surgery and SRS, respectively, appears to be a valuable tool for assessment of prognosis in patients with BrM.

Brain Neoplasms↗
PubMed2001

Posterior fossa meningiomas: surgical experience in 161 cases.

BACKGROUND: We report the clinical, radiological, and surgical findings of patients with posterior fossa meningiomas surgically treated at our institution over the last 6 years. METHODS: We reviewed 161 consecutive cases of posterior fossa meningiomas operated on between April 1993 and April 1999 at The George Washington University Medical Center. RESULTS: There were 128 female and 33 male patients (mean age 47 years, range of 10-81 years). Meningiomas were classified as petroclival (110 cases), foramen magnum (21 cases), cerebellar hemispheric, lateral tentorial (14 cases), cerebellopontine angle (9 cases), and jugular foramen (7 cases). Mean tumor equivalent diameter (TED) = (D1xD2xDE)(1/3) was 3.1 cm (range of 0.53-8.95). Head pain (50% of cases) and disturbance of gait (44%) were the most common presenting symptoms, and cranial neuropathies the most common neurological signs on admission. Mean preoperative performance status (Karnofsky scale) was 80.2 (range 40-100). Surgical approaches to these tumors included partial labyrinthectomy petrous apicectomy, fronto-temporal/fronto-temporal orbitozygomatic osteotomy, retrosigmoidal, extreme lateral, transpetrosal, and combined. In 38 cases a staged procedure was performed. Gross-total resection was achieved in 57% of patients, and subtotal/partial in 43%. Surgical mortality was 2.5% and complications were encountered in 41% of patients. Postoperative CSF leak occurred in 22 cases (13.6%). The mean follow-up was 19 months, ranging from 0.2 to 63.6, and the mean performance status of patients with a follow-up of at least 12 months was 77 (range of 40-100). Recurrence or progression of disease was found in 13.7% of cases (follow-up 2 years or more). CONCLUSION: Our experience suggests that although posterior fossa meningiomas represent a continuing challenge for contemporary neurosurgeons, such tumors may be completely or subtotally removed with low rate of mortality and acceptable morbidity, allowing most of these patients to achieve a good outcome in a long-term follow-up.

Adolescent↗
PubMedDate not supplied

Differences in pain knowledge in cancer patients with and without pain.

PURPOSE: The authors determined: 1) whether there were differences in knowledge about pain between oncology outpatients with and without cancer-related pain and 2) whether there were relationships between selected patient characteristics (age, gender, education, Karnofsky performance status, pain intensity, and pain duration) and the knowledge about pain of oncology outpatients with cancer-related pain. DESCRIPTION OF STUDY: Three hundred sixty-nine oncology outpatients completed several self-report questionnaires including a demographic questionnaire, a pain experience scale that measured knowledge about pain and pain management, the Karnofsky performance scale, and descriptive numeric rating scales that measured pain intensity and pain duration. RESULTS: Patients with cancer-related pain knew significantly more about pain and its management than pain-free patients (P < 0.004). However, in both groups, mean knowledge scores were below 60%. Older patients with cancer-related pain had less knowledge about pain than younger patients (P < 0.0001). In addition, patients with cancer pain who had more education and those with higher reported pain intensity scores had more knowledge about pain and pain management. Finally, women with cancer pain had more knowledge than men about pain and pain management. CLINICAL IMPLICATIONS: Results of this study suggest that oncology patients with and without pain need more education about pain and effective pain management strategies.

Adult↗
PubMed2005

Epidermal growth factor receptor amplification does not have prognostic significance in patients with glioblastoma multiforme.

PURPOSE: There have been conflicting reports in the literature regarding the prognostic significance of epidermal growth factor receptor (EGFR) amplification in patients with glioblastoma multiforme (GBM). The purpose of this study is to determine the prognostic significance of EGFR amplification in patients with GBM treated at the Cleveland Clinic Foundation. METHODS AND MATERIALS: A retrospective review of GBM patients treated with surgery at the Cleveland Clinic Foundation was performed. Amplification of EGFR was evaluated with fluorescence in situ hybridization in a total of 107 patients diagnosed between December 1995 and May 2003. In addition to EGFR status, various prognostic factors were evaluated to determine the factors that influenced survival and radiographic response rate. The median follow-up was 9 months. RESULTS: The overall median survival was 9.8 months, with a 1-year survival of 40%. Of the 107 patients in whom EGFR status was evaluated, 36 (33.6%) were found to have EGFR amplification. On multivariate analysis, median survival was found to be significantly improved for patients with age < 60 (12.6 months vs. 8 months, p = 0.0061), patients with Karnofsky Performance Status > or = 70 (12.1 months vs. 4.4 months, p < 0.0001), patients who had undergone subtotal resection or gross total resection (11.1 months vs. 4.1 months, p = 0.002), and patients who received a radiation dose > or = 60 Gy compared with no radiation (12.7 months vs. 3 months, p < 0.0001). There was no association of EGFR amplification with survival. When stratified by age (< 60 vs. > or = 60), EGFR status still did not reach statistical significance in predicting for survival. For the 81 patients who had radiographic follow-up, the 1-year overall local control was 14%. On univariate analysis, only treatment with radiation (< 60 Gy vs. > or = 60 Gy vs. no radiation, p = 0.03) was found to predict for improved local control. Treatment with radiation did not remain statistically significant on multivariate analysis. CONCLUSION: Epidermal growth factor receptor amplification was not found to be a significant prognostic indicator of overall survival or radiographic local control in patients with GBM treated with surgery at the Cleveland Clinic Foundation. Further studies are needed to fully delineate the significance of this molecular marker in patients with GBM.

Adult↗