title: KPS/LDH index: a simple tool for identifying patients with metastatic melanoma who are unlikely to benefit from palliative whole brain radiotherapy.
abstract: OBJECTIVE
  Low Karnofsky performance status (KPS) and elevated lactate dehydrogenases (LDHs) as a surrogate marker for tumor load and cell turnover may depict patients with a very short life expectancy. To validate this finding and compare it to other indices, namely, the recursive partitioning analysis (RPA) and diagnosis-specific graded prognostic assessment (DS-GPA), a multicenter analysis was undertaken.
  
  
  METHODS
  A retrospective analysis of 234 metastatic melanoma patients uniformly treated with palliative whole brain radiotherapy (WBRT) was done. Univariate and multivariate analyses were used to determine the impact of patient-, tumor-, and treatment-related parameters on overall survival (OS).
  
  
  RESULTS
  KPS and LDH emerged as independent factors predicting OS. By combining KPS and LDH values (KPS/LDH index), groups of patients with statistically significant differences in median OS (days; 95 % CI) after onset of WBRT were identified: group 1 (KPS ≥ 70/normal LDH) 234 (96-372), group 2 (KPS ≥ 70/elevated LDH) 112 (69-155), group 3 (KPS <70/normal LDH) 43 (12-74), and group 4 (KPS <70/elevated LDH) 29 (17-41). Between all four groups, statistically significant differences were observed. The RPA and DS-GPA indices failed to distinguish significantly between good and moderate prognosis and were inferior in predicting a very unfavorable prognosis.
  
  
  CONCLUSIONS
  The parameters KPS and LDH independently impacted on OS. The combination of both (KPS/LDH index) identified patients with a very short life expectancy, who might be better served by recommending best supportive care instead of WBRT. The KPS/LDH index is simple and effective in terms of time and cost as compared to other prognostic indices.
authors.affiliation: Department of Therapeutic Radiology and Oncology, Medical University Graz, Comprehensive Cancer Center Graz, Auenbruggerplatz 32, 8036, Graz, Austria. richard.partl@medunigraz.at.
authors.forename: Richard
authors.initials: R
authors.lastname: Partl
authors.affiliation: Department of Radiotherapy and Radio-Oncology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, 5020, Austria.
authors.forename: Gerd
authors.initials: G
authors.lastname: Fastner
authors.affiliation: Department of Radiotherapy and Radio-Oncology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, 5020, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Kaiser
authors.affiliation: Institute of Radiooncology, General Hospital, Wr. Neustadt, Vienna, 2700, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kronhuber
authors.affiliation: Institute of Radiooncology, General Hospital, Wr. Neustadt, Vienna, 2700, Austria.
authors.forename: Klaudia
authors.initials: K
authors.lastname: Cetin-Strohmer
authors.affiliation: Institute of Radiooncology, Kaiser-Franz-Josef-Spital, Vienna, 1100, Austria.
authors.forename: Claudia
authors.initials: C
authors.lastname: Steffal
authors.affiliation: Department of Radiooncology, Krems Hospital, Vienna, 3530, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Böhmer-Breitfelder
authors.affiliation: Department of Radiooncology, Krems Hospital, Vienna, 3530, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mayer
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Comprehensive Cancer Center Graz, Graz, 8036, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Avian
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Comprehensive Cancer Center Graz, Graz, 8036, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Berghold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000517:prevention & control* / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D045022:Lactate Dehydrogenases / Q000378:metabolism*; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000532:radiotherapy; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D045022:Lactate Dehydrogenases
keywords: Brain metastasis; LDH; Melanoma; Prognostic score; WBRT