Stereotactic Radiosurgery for Poor Performance Status Patients

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Clinical Outcomes Research

Background:

• Patients with poor performance status (PS), defined as Karnofsky Performance Status ≤60, are often excluded from stereotactic radiosurgery (SRS) trials.
• Current guidelines frequently recommend whole-brain radiation therapy (WBRT) as the primary treatment for this patient group.
• Limited data exists on the efficacy and safety of SRS in patients with poor PS and central nervous system (CNS) metastases.

Purpose of the Study:

• To evaluate the outcomes of stereotactic radiosurgery (SRS) in patients with poor performance status (PS) and central nervous system (CNS) metastatic disease.
• To compare SRS outcomes in this population with historical data or expectations for whole-brain radiation therapy (WBRT).

Main Methods:

• Retrospective review of a stereotactic radiosurgery (SRS) database.
• Inclusion of 36 patients with Karnofsky Performance Status (KPS) of 60 or less treated with SRS for CNS metastases.
• Analysis of overall survival (OS), local and distant failure rates, and treatment toxicity.

Main Results:

• Median overall survival (OS) was 7.2 months; 41% survived at 6 months and 16.6% at 1 year.
• No significant difference in OS was observed in patients with prior WBRT.
• No local failures or radiation toxicity were reported; distant CNS failures occurred in 25% of patients.

Conclusions:

• Patients with poor performance status (PS) treated with SRS for CNS metastases demonstrated reasonable median OS and low distant CNS failure rates.
• SRS may be a favorable alternative to WBRT for poor PS patients due to low failure rates and convenient single-fraction treatment.
• The findings suggest SRS is a safe and effective option for select debilitated patients with CNS metastases.