Stereotactic Radiosurgery for Poor Performance Status Patients.
Patients with poor performance status (PS), usually defined as a Karnofsky Performance Status of 60 or less, were not eligible for randomized stereotactic radiosurgery (SRS) studies, and many guidelines suggest that whole-brain radiation therapy (WBRT) is the most appropriate treatment for poor PS patients.



In this retrospective review of our SRS database, we identified 36 patients with PS of 60 or less treated with SRS for central nervous system (CNS) metastatic disease. PS, as defined by the Karnofsky Performance Status, was 60 (27 patients), 50 (8 patients), or 40 (1 patient). The median number of CNS lesions treated was 3.



Median overall survival (OS) was 7.2 months (range, 0.73-25.6 months). Fifteen patients (41%) were alive at 6 months, and 6 patients (16.6%) were alive at 1 year. There was no difference in OS in patients who underwent previous WBRT. There were no local failures or cases of radiation toxicity. Distant CNS failures were seen in 9 patients (25%).



Our patients with poor PS had reasonable median OS and relatively low distant CNS failure rates. Patients in this patient population may be ideal candidates for SRS compared with WBRT given the low incidence of distant failure over their remaining lives and the favorable logistics of single-fraction treatment for these patients with debility and their caregivers.
Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey. Electronic address: kubicek-gregory@cooperhealth.edu.
Gregory J
GJ
Kubicek
Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey.
Alan
A
Turtz
Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey.
Jinyu
J
Xue
Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey.
Ashish
A
Patel
Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey.
Gregory
G
Richards
Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey.
Tamara
T
LaCouture
Rowan Graduate School, Camden, New Jersey.
Louis
L
Cappelli
Rowan Graduate School, Camden, New Jersey.
Tim
T
Diestelkamp
Department of Diagnostic Radiology, Cooper University Hospital, Camden, New Jersey.
Piya
P
Saraiya
Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey.
Anne
A
Bexon
Department of Medical Oncology, Cooper University Hospital, Camden, New Jersey.
Nati
N
Lerman
Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey.
Howard Warren
HW
Goldman
D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000523:psychology / Q000532:radiotherapy*; D016371:Cranial Irradiation / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome