Karnofsky performance status and lactate dehydrogenase predict the benefit of palliative whole-brain irradiation in patients with advanced intra- and extracranial metastases from malignant melanoma.
OBJECTIVE
To determine prognostic factors that allow the selection of melanoma patients with advanced intra- and extracerebral metastatic disease for palliative whole-brain radiation therapy (WBRT) or best supportive care.


METHODS
This was a retrospective study of 87 patients who underwent palliative WBRT between 1988 and 2009 for progressive or multiple cerebral metastases at presentation. Uni- and multivariate analysis took into account the following patient- and tumor-associated factors: gender and age, Karnofsky performance status (KPS), neurologic symptoms, serum lactate dehydrogenase (LDH) level, number of intracranial metastases, previous resection or stereotactic radiosurgery of brain metastases, number of extracranial metastasis sites, and local recurrences as well as regional lymph node metastases at the time of WBRT.


RESULTS
In univariate analysis, KPS, LDH, number of intracranial metastases, and neurologic symptoms had a significant influence on overall survival. In multivariate survival analysis, KPS and LDH remained as significant prognostic factors, with hazard ratios of 3.3 (95% confidence interval [CI] 1.6-6.5) and 2.8 (95% CI 1.6-4.9), respectively. Patients with KPS ≥70 and LDH ≤240 U/L had a median survival of 191 days; patients with KPS ≥70 and LDH >240 U/L, 96 days; patients with KPS <70 and LDH ≤240 U/L, 47 days; and patients with KPS <70 and LDH >240 U/L, only 34 days.


CONCLUSIONS
Karnofsky performance status and serum LDH values indicate whether patients with advanced intra- and extracranial tumor manifestations are candidates for palliative WBRT or best supportive care.
Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria. richard.partl@medunigraz.at
Richard
R
Partl
Erika
E
Richtig
Alexander
A
Avian
Andrea
A
Berghold
Karin S
KS
Kapp
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood*; D001932:Brain Neoplasms / Q000201:enzymology / Q000532:radiotherapy* / Q000556:secondary; D016371:Cranial Irradiation / Q000379:methods*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D008545:Melanoma / Q000201:enzymology / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult
D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase