Mean Karnofsky Performance Score Research Articles

Snapshot of International Radıotherapy Center: Single Center Experience

Cancer can become anywhere in the human body almost including trillions of cells. Cancerous tumors spread or invade into the tissues to form new tumors that named as the process of metastasis. Radiation therapy (RT) was first used to treat cancer over a hundred years ago. The progress has been made to improve the effectiveness of this awesome modality and minimize side effects. RT also has been used with surgery, chemotherapy or immunotherapy in combined modality approaches for numerous malignancies to maximize tumor control while minimizing toxicity and preserving the organs and tissues. We intend to present our patient population whom delivering radiotherapy in our radiotherapy center. The data includes the patients who still delivering radiotherapy, initial or last day of radiotherapy. This article is about a snapshot of a treated patient population in one day at our center. Mean KPS (Karnofsky Performance Score) was 90 (70-100). 2 patients were in stage 1 (2%), 25 (28%) were in stage 2, 35 (39%) wee in stage 3 and remaining 23 (26%) were in stage 4. 4 (5%) of all were benign.

Spinal oncologic paraparesis: Analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors.

Paraparesis due to oncologic lesions of the spine warrants swift neurosurgical intervention to prevent permanent disability and hence maintain independence of affected patients. Clinical parameters that predict a favorable outcome after surgical intervention could aid decision-making in emergency situations. Patients who underwent surgical intervention for paraparesis (grade of muscle strength <5 according to the British Medical Research Council grading system) secondary to spinal neoplasms between 2006 and 2020 were included in a single-center retrospective analysis. Pre- and postoperative clinical data were collected. The neurological status was assessed using the modified McCormick Disability Scale (mMcC) Score. In a univariate analysis, patients with favorable (discharge mMcC improved or stable at <3) and non-favorable outcome (discharge mMcC deteriorated or stable at >2) and different tumor anatomical compartments were statistically compared. 117 patients with oncologic paraparesis pertaining to intramedullary lesions (n=17, 15%), intradural extramedullary (n=24, 21%) and extradural lesions (n=76, 65%) with a mean age of 65.3 ± 14.6 years were included in the analysis. Thoracic tumors were the most common (77%), followed by lumbar and cervical tumors (13% and 12%, respectively). Surgery was performed within a mean of 36±60 hours of admission across all tumors and included decompression over a median of 2 segments (IQR:1-3) and mostly subtotal tumor resection (n=83, 71%). Surgical and medical complications were documented in 9% (n=11) and 7% (n=8) of cases, respectively. The median hospital length-of-stay was 9 (7-13) days. Upon discharge, the median mMcC score had improved from 3 to 2 (p<0.0001). At last follow-up (median 180; IQR 51-1080 days), patients showed an improvement in their mean Karnofsky Performance Score (KPS) from 51.7±18.8% to 65.3±20.4% (p<0.001). Localization in the intramedullary compartment, a high preoperative mMcC score, in addition to bladder and bowel dysfunction were associated with a non-favorable outcome (p<0.001). The data presented on patients with spinal oncologic paraparesis provide a risk-benefit narrative that favors surgical intervention across all etiologies. At the same time, they outline clinical factors that confer a less-favorable outcome like intramedullary tumor localization, a high McCormick score and/or bladder and bowel abnormalities at admission.

Combined Application of Sodium Fluorescein and Neuronavigation Techniques in the Resection of Brain Gliomas.

Objectives: To explore the effectiveness and safety of the combined application of sodium fluorescein and neuronavigation techniques in the resection of brain gliomas in different locations and patients of different ages.Methods: Fifty clinical cases of brain gliomas treated at the Department of Neurosurgery of Beijing Tiantan Hospital were collected from March 2014 to March 2019. These cases were divided into a supratentorial group (24 cases) and a brainstem group (26 cases) based on location and an adult group (28 cases) and a pediatric group (22 cases) based on age. Fluorescein-guided surgery was performed: the adult group received 5 mg/kg sodium fluorescein before opening the dura, while the pediatric group received 2.5 mg/kg during resection. Tumor visualization was evaluated by the enhancement of yellow fluorescein and considered “satisfactory” if the illumination demarcated the tumor boundary. Additionally, the consistency between fluorescein and neuronavigation was analyzed. The Karnofsky performance score (KPS) of all patients was recorded and assessed at admission, discharge, and the 6-month follow-up.Results: In the 28 adult cases, 4 were unsatisfactory, while in the 22 pediatric cases, 2 were unsatisfactory; in 7 cases, there was an inconsistency between yellow fluorescein enhancement and neuronavigation, 6 were in the supratentorial group, and 1 was in the brainstem group. Statistical analysis showed no significant differences in the satisfactory rate between the adult and pediatric groups (P = 0.575), whereas there were significant differences inconsistency between the supratentorial group and brainstem group (P = 0.031). The mean KPS at admission was between 70 and 100, which was not significantly different from that at discharge (P = 0.839), but the KPS at the 6-month follow-up was significantly higher than that at admission (P = 0.041).Conclusions: The consistency between sodium fluorescein and the neuronavigation system was higher in the brainstem group than in the supratentorial group; a half dose of sodium fluorescein (2.5 mg/kg) was sufficient for pediatric patients. The combined utilization of sodium fluorescein and neuronavigation techniques may confer glioma patients the opportunity to obtain better clinical outcomes after surgery.

C-methionine-PET-guided Gamma Knife radiosurgery boost as adjuvant treatment for newly diagnosed glioblastomas

Background: The most common glial tumor is the glioblastoma, and the prognosis remains dismal despite a multimodal therapeutic approach. The role of radiosurgery for the treatment of glioblastomas has been evaluated in several studies with some benefit at the recurrent stage. We evaluate the results of the protocol administered at the Gamma Knife unit administering radiosurgery as a boost to metabolic active parts of the tumor after the patient had completed traditional external beam radiotherapy (XBRT) as part of the Stupp protocol for high-grade gliomas.Methods: This is a retrospective analysis of seven patients with newly diagnosed glioblastomas who were treated with Gamma Knife radiosurgery as a boost after receiving XBRT as part of the Stupp protocol. The target of radiation was determined according to the findings of the C-methionine PET scan in relation to magnetic resonance images. The primary end point of this study was to determine the progression-free survival (PFS) from the time of diagnosis.Results: The median age of patients was 48.8 years and the mean Karnofsky performance score was 92.8%. The median PFS was 12.4 months. No radiation adverse effects were documented.Conclusion: Stereotactic radiosurgery is safe to use in the upfront treatment for these patients and appears to have a beneficial role in improving the PFS. This beneficial role seems to be conditioned not only by the time the treatment is administered but also where the radiation dose is targeted to.

Outcome of Older Patients with Acute Neuropsychological Symptoms Not Fulfilling Criteria of Delirium.

Although delirium is often investigated, little is known about the outcomes of patients having acute neuropsychological changes at a single time point without fulfilling the criteria of full delirium. Our aim was to determine point prevalence, predictors, and long-term outcomes of delirium and acute neuropsychological changes in patients aged 60 years and older across different departments of a university hospital with general inpatient care. Prospective observational study. University hospital excluding psychiatric wards. At baseline, 669 patients were assessed, and follow-ups occurred at months 6, 12, 18, and 36. Measurements were obtained using the Confusion Assessment Method (CAM), comprehensive geriatric assessment, health-related quality of life, functional state (month 6), and mortality rates (months 6, 12, 18, and 36). Subjects were classified into (1) patients with delirium according to the CAM, (2) patients with only two positive CAM items (2-CAM state), and (3) patients without delirium. Delirium was present in 10.8% and the 2-CAM state in an additional 12.7% of patients. Highest prevalence of delirium was observed in medical and surgical intensive care units and neurosurgical wards. Cognitive restrictions, restricted mobility, electrolyte imbalance, the number of medications per day, any fixations, and the presence of a urinary catheter predicted the presence of delirium and 2-CAM-state. The mean Karnofsky Performance Score and EuroQol-5D were comparable between delirium and the 2-CAM state after 6 months. The 6-, 12-, 18-, and 36-month mortality rates of patients with delirium and the 2-CAM state were comparable. The nurses' evaluation of distinct patients showed high specificity (89%) but low sensitivity (53%) for the detection of delirium in wide-awake patients. Patients with an acute change or fluctuation in mental status or inattention with one additional CAM symptom (ie, disorganized thinking or an altered level of consciousness) have a similar risk for a lower quality of life and death as patients with delirium. J Am Geriatr Soc 68:1469-1475, 2020.

Intraoperative computed tomography, navigated ultrasound, 5-amino-levulinic acid fluorescence and neuromonitoring in brain tumor surgery: overtreatment or useful tool combination?

Brain tumor surgery is routinely supported by several intraoperative techniques, such as fluorescence, brain mapping and neuronavigation, which are often used independently. Efficacy of navigation is limited by the brain-shift phenomenon, particularly in cases of large or deep-sited lesions. Intraoperative imaging was introduced also to update neuronavigation data, to try and solve the brain-shift phenomenon-related pitfalls and increase overall safety. Nevertheless, each intraoperative imaging modality has some intrinsic limitations and technical shortcomings, making its clinical use challenging. We used a multimodal intraoperative imaging protocol to update neuronavigation, based on the combination of intraoperative Ultrasound (i-US) and intraoperative Computed Tomography (i-CT) integrated with 5-ALA fluorescence and neuromonitoring-guided resection. This is a pilot study on 52 patients (29 men), including four children, with a mean age of 57.67 years, suffering from brain low- (N.=10) or high-grade (N.=34) glioma or metastasis (N.=8), prospectively and consecutively enrolled. They underwent 5-ALA fluorescence-guided microsurgical tumor resection and neuromonitoring was used in cases of lesions located in eloquent areas, according to preoperative clinical and neuroradiological features. Navigated B-mode ultrasound acquisition was carried out after dural opening to identify the lesion. After tumor resection, i-US was used to identify residual tumor. Following further tumor resection or in cases of unclear US images, post-contrast i-CT was performed to detect and localize small tumor remnants and to allow further correction for brain shift. A final i-US check was performed to verify the completeness of resection. Clinical evaluation was based on comparison of pre- and postoperative Karnofsky Performance Score (KPS) and assessment of overall survival (OS) and progression-free survival (PFS). Extent of tumor resection (EOTR) was evaluated by volumetric postoperative Magnetic Resonance performed within 48 h after surgery. Forty-one of the 52 (78.8%) patients were alive and still under follow-up in December 2017. 5-ALA was strongly or vaguely positive in 45 cases (86.5%). Seven lesions (four low-grade glioma, one high-grade glioma, and two metastases) were not fluorescent. i-US visualized residual tumor after resection of all fluorescent or pathological tissue in 22 cases (42.3%). After i-US guided resection, i-CT documented the presence of further residual tumor in 11 cases (21.1%). Mean EOTR was 98.79% in the low-grade gliomas group, 99.84% in the high-grade gliomas group and 100% in the metastases group. KPS changed from 77.88, preoperatively, to 72.5, postoperatively. At the last follow-up, mean KPS was 84.23. The combination of different intraoperative imaging modalities may increase brain tumor safety and extent of resection. In particular, i-US seems to be highly sensitive to detect residual tumors, but it may generate false positives due to artifacts. Conversely, i-CT is more specific to localize remnants, allowing a more reliable updating of navigation data.

Sleep quality with WHO Step III opioid use for cancer pain

ObjectiveSleep is often disturbed in patients with advanced cancer. There is limited knowledge about sleep in patients with cancer treated with strong opioids. This study examines sleep quality in patients...

Stand-alone craniocervical decompression is feasible in children with mucopolysaccharidosis type I, IVA, and VI

Background ContextIn patients with mucopolysaccharidosis (MPS), glycosaminoglycan deposits in the dura mater and supporting ligaments cause spinal cord compression and consecutive myelopathy, predominantly at the craniocervical junction. Disease characteristics of craniocervical stenosis (CCS) in patients with MPS differ profoundly from other hereditary and degenerative forms. Because of high periprocedural morbidity and mortality, patients with MPS pose a substantial challenge to the inexperienced medical care provider. As literature remains scarce, we present our experience with a large cohort of patients with MPS treated for CCS without atlanto-occipital instrumentation. PurposeThe present study aimed to describe a safe and least traumatic approach for treating CCS in children with MPS, avoiding primary instrumentation. Study DesignThis is a prospective follow-up (cohort) study. Patient SamplesWe report 15 consecutive patients with CCS related to MPS, who were treated with stand-alone cervical decompression. Outcome MeasuresMyelopathy was assessed using magnetic resonance imaging (MRI), somatosensory evoked potentials, and clinical evaluation. Cervical instability was evaluated using plain x-ray and MRI. The disability status is quantified using either the Karnofsky or Lansky Performance Score. MethodsWe describe 15 consecutive patients treated with craniocervical decompression. Data were collected prospectively. The mean follow-up is 6 years (5 standard deviation). The technique and treatment principles are described. ResultsThe overall clinical outcome in this patient cohort is good (mean Karnofsky Performance Score of 80). No patient developed signs of C0-C1-C2 instability or progressive myelopathy. Restenosis occurred in seven patients, requiring a total of eight reoperations. ConclusionsSurgery in patients with MPS is associated with high morbidity and mortality of up to 4.2%. Because of the unique nature of the disease, recurring stenosis is inevitable. To shorten the procedure time and simplify the anticipated reoperation, we provide data that craniocervical decompression is feasible without the necessity of primary osteosynthesis. In the absence of craniocervical instability, decompression surgery without occipitocervical stabilization yields good postoperative results and challenges the long-standing paradigm of prophylactic craniocervical fixation.

Lactate dehydrogenase as a prognostic marker in neoplastic meningitis

This study aimed to establish the prognostic utility of lactate dehydrogenase (LDH) levels in the cerebrospinal fluid (CSF) of patients with neoplastic meningitis (NM). Patients with a confirmed diagnosis of NM at a cancer referral center were included. Data on demographic and oncological background, clinical symptoms, diagnostic tests, treatment, and survival were analyzed. In total, 119 patients were included, 74% of whom were females. The mean age was 44.2 years at the time of cancer diagnosis and 46.6 years at the time between NM diagnosis. Primary cancers were mostly breast cancer, lung cancer, or hematologic malignancies. The mean Karnofsky performance score (KPS) was 65. Frequent clinical symptoms were visual complaints, headache, cranial neuropathy, focal weakness, and decreased awareness. Diagnosis was made based on clinical symptoms, cytological CSF analysis results, and/or magnetic resonance imaging findings. The median overall survival (OS) was 4 months (95% CI 2.48–5.52). Prognostic variables associated with a better OS were hematopoietic malignancies, KPS ≥ 70, absence of meningeal signs, receiving any form of treatment, normal CSF glucose levels, and normal CSF LDH levels. After bivariate analysis, high LDH in the CSF remained statistically significant as a poor prognostic indicator.The LDH level is a useful parameter to assess the prognosis of patients with NM. Other factors associated with the prognosis of these patients were tumor type, CSF glucose levels, performance status, and receiving any form of treatment.

PATIENT CHARACTERISTICS OF PALLIATIVE UNITS AND THE RELATIONSHIP BETWEEN PALLIATIVE UNITS AND INTENSIVE CARE

Ponte Academic JournalNov 2018, Volume 74, Issue 11 PATIENT CHARACTERISTICS OF PALLIATIVE UNITS AND THE RELATIONSHIP BETWEEN PALLIATIVE UNITS AND INTENSIVE CAREAuthor(s): Iskender Kara ,Iskender Kara, Bekir Tezcan, Hasan Nabi Undar, Halit Karaca, Faruk CicekciJ. Ponte - Nov 2018 - Volume 74 - Issue 11 doi: 10.21506/j.ponte.2018.11.4 Abstract:Background: The relationship between palliative units and intensive care is an under-examined issue. \r\nObjectives: This study was aimed to investigate general characteristics of patients in palliative care unit(PCU) and patient transfers between these units and intensive care units(ICU).\r\nMethod: Patients who were followed up at the PCU were reviewed retrospectively. The study group patients were divided into three groups as a discharge, ICU transfer and exitus. The characteristics of patients receiving both palliative care after intensive care and intensive care after palliative care treatment were evaluated.\r\nResults: A total of 337 patients were followed in the PCU during the study period. 138 of these patients were admitted from the ICU. The mortality rate of the PCU was 16.3%(55 patients). The mortality were higher in patients with malignancy-related complications (p<0,001) and the discharge rate were higher in patients with orthopedic reasons(p=0.016). Exitus group had longer palliative hospitalizations(p=0.008), while ICU transfers group had longer hospitalizations(p<0.001). The mean Karnofsky Performance Score was significant higher in the discharge group (p < 0.001). Palliative care patients were transferred to ICU at a rate of 10.1%(n:34). The patients were mostly transferred into ICU for respiratory failure (91,2%), unconsciousness (82,4%), hemodynamic problems (70,6%) and infections (52,9%). The mortality rate was 97%(n:33) in the ICU transfer group. Only one patient (3%) was returned to palliative unit after ICU.\r\nConclusion: The patients with high mortality that would not benefit from intensive care treatment would be more suitable to follow up in the PCU in the end of their life. Download full text:Check if you have access through your login credentials or your institution Username Password

Effects of preventive versus “on-demand” nutritional support on paid labour productivity, physical exercise and performance status during PEG-interferon-containing treatment for hepatitis C

Deterioration of nutritional status during PEG-interferon containing therapy for chronic hepatitis C can be ameliorated by preventive nutritional support. We aimed to explore whether such support also affects paid labour productivity, physical exercise and performance status. In this prospective randomized controlled trial (J Hepatol 2012;57:1069-75), 53 patients with chronic hepatitis C had been allocated to "on demand" support (n=26: nutritional intervention if weight loss>5%) or preventive support (n=27: regular dietary advice plus energy- and protein-rich evening snack) during PEG-interferon-containing therapy. Paid labour productivity, physical exercise and performance status were evaluated at baseline, after 24 and (if applicable) after 48 weeks of treatment. At baseline, 46% of patients performed paid labour and 62% performed some kind of physical exercise. Furthermore, most patients were able to carry out normal activity with only minor symptoms of disease (mean Karnofsky performance score: 94). Decreases of paid labour productivity (-21% vs. -70%, P=0.003), physical exercise activity (-43% vs. -87%, P=0.005) and Karnofsky performance scores (-12% vs. -24%, P<0.001) were less in the preventive than in "on demand" group after 24 weeks of treatment. Effects of preventive nutritional support were even more pronounced after 48 weeks. Preventive nutritional support markedly ameliorates decreases of paid labour productivity, physical exercise and performance status during PEG-interferon-containing treatment for chronic hepatitis C.

177Lu-EDTMP for Treatment of Bone Pain in Patients with Disseminated Skeletal Metastases

(177)Lu-labeled ethylenediaminetetramethylene phosphonic acid ((177)Lu-EDTMP) is an agent that concentrates in areas of enhanced osteoblastic activity. The potential of (177)Lu-EDTMP for palliation of metastatic bone pain has been documented in the recent literature. The objective of the present work was to study the efficacy and safety of the agent after administration to a limited number of patients. Ten patients (median age, 68.5 y) with disseminated skeletal metastases received a single bolus infusion of (177)Lu-EDTMP (3.7 GBq). All patients had painful bone metastases in more than one anatomic region that were not relieved by narcotic analgesics. The efficacy of the agent was studied by following pain scores assessed at baseline and at 4, 8, and 12 wk after therapy, by using Karnofsky indices and mobility scores, and by determining the requirement for analgesics at baseline and 4 wk after therapy. The toxicity of the agent was assessed by analyzing complete blood counts. A significant reduction in the mean pain score was noted in all patients. The initial mean pain score of 8.44 dropped to 5.73 within 1 mo of treatment. Six patients who required analgesics for pain management had either reduced or completely withdrawn from their use by 4 wk. Compared with initial scans, scans obtained 1 mo after therapy also showed a decreased uptake of the radiotracer. The mobility scores of all patients were higher at 4 wk. The mean Karnofsky performance score of all patients was initially 45 and increased markedly to 69 at 4 wk. None of the patients experienced blood-related toxicity. (177)Lu-EDTMP, with only low bone marrow toxicity, provided significant pain relief to patients and considerably increased their mobility, resulting in an overall improvement in the quality of life. The results of the preliminary clinical studies indicate that (177)Lu-EDTMP can be considered an effective and safe therapeutic radiopharmaceutical for pain palliation of patients with disseminated skeletal disease.

Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and re-evaluation of treatment efficacy

In high-risk and unfit-for-surgery patients with acute cholecystitis (AC), treatment options are controversial. Few studies have reported the results of long-term follow-up. This study aimed to evaluate the clinical course of patients after removal of the percutaneous cholecystostomy (PC) catheter in high-risk patients with AC, time interval to relapse, and factors influencing relapse. From 2000 to 2011, 183 patients with AC underwent PC and catheter removal in Seoul National University Hospital and Boramae Hospital, Korea. Sixty cases were reviewed retrospectively after excluding cases with intended interval cholecystectomy, malignant biliary obstruction, loss to follow-up, and insufficient follow-up information. The mean age was 68.6 ± 13.8 years, and the mean Karnofsky performance score was 24.8 ± 9.7. After insertion of a PC catheter, symptom resolution and improvement on imaging were achieved in 95% and 97.9% of patients, respectively. Laboratory values were also improved (P < .01). There was no mortality during admission; 2 patients (3.3%) experienced complications during removal of the PC catheter. Relapse was observed in 7 patients (11.7%) during a median follow-up of 38.1 ± 24.8 months. There were no differences in clinical, laboratory, or imaging findings between relapsing and nonrelapsing patients. Therefore, prediction of relapse was not possible. Among high-risk patients with AC, 88.3% were managed with PC without relapse within a median follow-up period of 38.1 months, despite radiologically severe AC in some patients. We conclude that a temporary PC can be a first-line treatment for AC without interval cholecystectomy.

Modular hemipelvic endoprosthesis reconstruction–Experience in 100 patients with mid-term follow-up results

IntroductionPelvic endoprostheses are becoming more commonly used in recent years. In 2007, we reported the early results of modular hemipelvic endoprosthesis. In order to provide longer follow-up results, we conducted the current study. ObjectiveTo explore overall survival, local recurrence rate, metastasis rate, function score and survivorship of the prosthesis and related complications. MethodsWe retrospectively reviewed one hundred consecutive patients who received reconstruction with modular hemipelvic endoprostheses from June 2001 to March 2010. The living patients were followed for an average of 52.9 (range, 24–103) months. There were 85 primary tumors and 15 isolated metastases. ResultsAt the time of last follow-up, fifty-eight patients were alive with no evidence of disease and thirty-six patients died of disease. Twenty patients experienced a local recurrence and twenty-eight patients developed distant metastasis. Patients with wide surgical margins had a significantly lower local recurrence rate than those with inadequate margins (p = 0.03). The mean MSTS (Musculoskeletal Tumor Society) 93 score was 57.2% (range, 16.7–86.7%). The mean Karnofsky Performance Score (KPS) was 64.4 (range, 30–90). Postoperative complications occurred in 45% of the patients. Wound healing disturbance (18%) and deep infection (15%) were the most predominant. Less frequent complications included dislocation, which occurred in nine patients and mechanical complications including 5 breakages and 2 aseptic loosening. ConclusionThe modular hemipelvic endoprosthesis can provide a versatile reconstruction option for a variety of pelvic defects with an acceptable rate of complication. Wide margins whenever possible should be the goal for these complex patients.

Survival of brain metastatic patients treated with gamma knife radiosurgery alone

PurposeTo evaluate the impact of gamma knife radiosurgery (GKRS) alone on the survival of brain metastasis patients. MethodsFifty patients, 17 men and 33 women, with 169 metastatic tumors were retrospectively reviewed. Before therapy, their mean Karnofsky Performance Score was 78. The majority of their primary cancers stemmed from the lung (56%). Thirty-five patients harbored multiple tumors. The mean tumor volume was 3.7ml. The mean margin dose was 16Gy. The mean/median clinical follow-up period was 37/25 weeks. ResultsThe overall image-proven tumor control rate was 76%, and the median tumor progression-free period was 26 weeks after radiosurgery. The survival rate of the patients was 58% and 30% at 6 and 12 months, respectively, and the overall median post-radiosurgery survival time was 38 weeks. Both uni- and multi-variate Cox analyses demonstrated that patients with KPS≧80 or who were in Recursive Partitioning Analysis Class I survived significantly longer (p<0.05). ConclusionsPatients treated with GKRS alone can prolong their median lifespan by a range of 6–10 months if they are in a good pre-GKRS functional state.

Interviews with patients with advanced cancer—another step towards an international cancer pain classification system

Patients' involvement in the development of assessment tools is recommended, and the European Palliative Care Research Collaborative has adhered to this when developing a shared language for cancer pain, an international assessment and classification system. Study objectives were to investigate how patients ranked the relevance of several previously identified pain domains, to investigate patients' perception of the pain experience and to disclose additional, relevant pain domains for cancer pain classification to those identified in the literature. Semistructured interviews with advanced cancer patients treated with opioids were performed and analysed verbatim. Patients scored the relevance of predefined pain domains on an 11-point Numerical Rating Scale. Thirty-three Norwegian and Austrian patients were included (16 females and 17 males); the mean age was 63 years, and the mean Karnofsky performance score was 65. The ranking of domains was as follows etiology (mean Numerical Rating Scale score, 8.5), duration (8.0), intensity (7.4), coping (7.1), physical (5.9) and psychological functioning (5.8). Sleep was identified as a new candidate domain to include in the system. The patients emphasised consequences of having pain, for example, poor physical functioning and psychological distress. Previously identified pain domains were confirmed to be relevant to the patients; however, the ranking differed from the experts' ranking. Sleep disturbances may be added as a domain in a future classification system.

Validity of the Graded Prognostic Assessment–Derived Index to Predict Brain-Metastatic Patients' Survival After Gamma Knife Radiosurgery

To appraise whether the graded prognostic assessment (GPA)-derived index is valid for selecting patients with brain metastases for Gamma Knife (GK) radiosurgery. A total of 56 consecutive patients in recursive partioning analysis (RPA) Class I (n = 19, 34%) and II (n = 37, 66%) formed the basis of this retrospective study. Their mean age was of 57 years with mean Karnofsky performance score of 77. Primary cancers stemmed mainly from the lungs (59%). A total of 45 patients (80%) harbored multiple tumors. The mean clinical follow-up period was 9 months. Kaplan-Meier analysis demonstrated that the overall median survival time (MST) for the whole series was 11.5 months: 16.5 vs. 6.5 months for RPA class I and II (p = 0.017). Multivariate Cox analysis revealed that female patients and a pre-GK good functional state were favorable prognostic factors. The favorable MST was in patients with a GPA score of 3 to 4 (17 months) followed by a GPA score of 2 to 2.5 (11 months) and GPA score 0 to 1.5 (6.5 months), but without statistical differences (p = 0.413) in between. A modified index (MGPA) is proposed with gender as a cofactor, then there existed a distinct survival differences (p = 0.028) between patients with an MGPA score of 3.5 to 5 (15 months) and with an MGPA score of 0 to 3 (7 months). In addition, the original GPA index failed to imply the difference of MST in patients with lung origin. The GPA-derived index is not applicable to our set of patients for comparing their survival after GK radiosurgery. The gender of the patients is a suggested cofactor to further refine the greater prognostic accuracy of the GPA index.

Anticancer Effects of HESA-A in Patients With Metastatic Colon Cancer

HESA-A is a natural biological compound of herbal-marine origin. The aim of this study was to investigate the therapeutic effects of HESA-A in patients with metastatic colon cancer. Fifty consecutive patients with end-stage colon cancer and liver metastasis at the Cancer Research Center of Tehran University of Medical Sciences were studied. Patients received HESA-A 50 mg/kg/d orally in 2 to 3 divided doses for 6 months. The patients were assessed at the start and end of the 1st, 2nd, 4th, 8th, 12th, 16th, 20th, and 26th weeks of the study. The Karnofsky Performance Scale questionnaire was completed for each patient. The mean Karnofsky performance score increased from 33.6 +/- 9.8 to 63.3 +/- 11 after 10 weeks of study. No significant hepatic or hematological adverse effects were seen during the study. It seems that HESA-A is an effective and safe anticancer drug, which can be used in selected patients.

The effect of hyperglycemia on survival in patients with glioblastoma multiforme

2013 Background: Steroid-induced hyperglycemia is rarely carefully managed in patients with glioblastoma multiforme (GBM) unless acute complications of hyperglycemia are present; however epidemiologic and laboratory studies suggest that hyperinsulinemia and/or hyperglycemia may promote tumor growth. We aimed to evaluate whether hyperglycemia was associated with decreased survival in patients with GBM. Methods: 191 patients with newly diagnosed GBM were accrued to New Approaches to Brain Tumor Therapy CNS Consortium trials with similar eligibility criteria between 1999 and 2005, prior to the standard use of temozolomide. 123 patients (64%) had glucose values and glucocorticoid doses recorded every 2 months for at least 6 months after accrual or until death. For each subject, mean glucose and mean glucocorticoid dose were calculated from all available results after weighting each value according to the number of days between it and the next record or the censor date. The primary outcome was survival. Results: The mean age was 55.7 years (SD 11.2 years) and the mean Karnofsky performance score at the time of accrual was 87 (SD 10.2). The median of subjects’ average glucocorticoid dose was 5 mg/day (range 0–64 mg) of dexamethasone or the equivalent. The median average glucose was 110 mg/dl (range 65–459 mg/dl), and 41 patients (21%) had a mean glucose > 140 mg/dl (the cut-off for impaired glucose tolerance). The median survival was longer in subjects with a mean glucose < 140 mg/dl than > 140 mg/dl (372 days versus 230 days, p=0.005). After adjusting for age, sex, race, baseline Karnofsky performance status, and mean glucocorticoid dose, every 10 mg/dl increase in mean glucose was associated with a 3% increase in the risk of death (95% CI: 0%-6%, p=0.034). Conclusions: In a group of patients with GBM and a good baseline performance status, hyperglycemia was associated with shorter survival after controlling for measured confounders. Interventional studies are needed to determine whether intensive management of glucocorticoid-related hyperglycemia in patients with GBM improves survival. No significant financial relationships to disclose.

Palliative Radiotherapy Improves Pain and Reduces Functional Interference in Patients with Painful Bone Metastases: A Quality Assurance Study

Aims To characterise the effect of palliative radiotherapy treatment outcomes as evaluated by the Brief Pain Inventory within a radiotherapy clinic, as a quality assurance initiative. Materials and methods Tumour and treatment parameters of patients with painful bone metastases treated through a dedicated bone pain radiotherapy clinic have been prospectively recorded since 2002. One hundred and nine ambulatory patients provided pre- and post-treatment pain assessments at 4–6 weeks after palliative radiotherapy. The self-administered Brief Pain Inventory questionnaire was completed by patients during their visits. Changes in pain and seven-item functional interference scores were analysed. Results Most of the patients had prostate ( n = 42) or breast ( n = 42) cancer. The mean Karnofsky performance score was 70 before palliative radiation therapy. Sixty-eight per cent of patients were treated with a single fraction (6–8 Gy) and 25% received 20 Gy/five fractions. The overall response (reduction in worst pain by ≥2/10) was 72%. Sixty-one per cent of patients had stable or reduced consumption of opioid analgesics. A significant reduction for all seven functional interference items was seen after treatment, the greatest improvement being general activity (−2.4/10). There was significant correlation between pain reduction and improvement in functional interference. Conclusion This quality assurance initiative showed that palliative radiotherapy reduced both pain and its interference on function among ambulatory patients with symptomatic bone metastases. The reduction in pain was correlated with reductions in functional interference. Clinical trials of palliative radiotherapy should provide data that allow an evaluation of various domains of chronic pain.