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Impact of Radiosurgical Management of Geriatric Patients With Brain Metastases: Clinical and Quality of Life Outcomes
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Volume 87 Number 2S Supplement 2013 were general activity (60%) and mood (60%). Meaningful improvements were reported by 31% (mean score 4.35, SD 3.12) and 32% (mean score 3.85, SD 2.9) of these patients respectively. Among all patients, the most commonly reported instances of worsened QOL were drowsiness (33.3%) and dry mouth (32.4%). For the entire cohort, a median of 33% (17%56%) of symptomatic patients reported meaningful improvements when considering all domains together, while 24% (5%-32%) reported worsening QOL (p < 0.0001). There were no significant differences in MDASISP outcomes whether single fraction or hypofractionated SRS was given. Conclusions: The current analysis showed that in the majority of patients the QOL improved or showed no significant change after SRS. The lack of decline in the QOL is consistent with prevention of symptomatic tumor progression due to the effective tumor control provided by SRS and the lack of meaningful toxicity. Long-term follow-up data will be required in order to delineate the risk factors for QOL decline after SRS. Author Disclosure: Y. Yamada: F. Honoraria; Institute for Medical Education. G. Consultant; Varian Medical Systems. H. Travel Expenses; American Brachytherapy Society. T. Tam: None. T. Atkinson: None. L. Friguglietti: None. I. Laufer: None. J. Zatcky: None. M. Bilsky: None.
3061 Impact of Radiosurgical Management of Geriatric Patients With Brain Metastases: Clinical and Quality of Life Outcomes D. Randolph, A.M. Peiffer, H. Klepin, D.N. Ayala-Peacock, S.C. Lester, A.W. Laxton, S.B. Tatter, E.G. Shaw, and M.D. Chan; Wake Forest Baptist Medical Center, Winston Salem, NC Purpose/Objective(s): Recent trials have shown that whole brain radiation therapy (WBRT) can worsen performance status, particularly in the geriatric population. We reviewed our institutional experience with geriatric patients ( 70 years) with brain metastases treated with gamma radiosurgery (GRS) to determine if geriatric patients have any different clinical outcomes than younger patients, and to assess quality of life measures in the elderly after GRS. Materials/Methods: Between 7/2000 and 1/2013, a retrospective review was performed on a total of 468 patients treated with GRS (N Z 114 patients 70, N Z 354 <70 years). Clinical outcomes were overall survival (OS), cause of death, and subsequent whole brain radiation (WBRT). A subset of geriatric patients were prospectively followed with assessments of Karnofsky performance score (KPS, N Z 69), mini-mental status examinations (MMSE, N Z 39), and Spitzer quality of life assessments (N Z 39) at initial interview, 6 months, and 12 months after GRS. Repeated Measures ANOVA was used to evaluate differences in longitudinal quality of life values. Kaplan-Meier analysis was used to estimate survival and time to WBRT. Results: Patients 70 years had a shorter OS compared to younger patients (median 6 vs 8 months, p < 0.035). Fewer patients in the 70 cohort received whole brain (11.4% vs 30.8%, p < 0.001) or subsequent GRS (15.8% vs 26.3%, p < 0.025) as compared to younger patients. No difference was seen between the population <70 and 70 in cause of death, (<70 vs 70, neurologic death 29.1% vs 27.2% respectively, p < 0.4). Among available geriatric patients, KPS was not statistically different in the geriatric population between 0, 6, or 12 months after GRS. Spitzer scores declined from 0 to 6 months (mean 10.7 and 5.4 respectively, p < 0.02) and 0 to 12 months (mean 10.7 and 5.6, respectively, p < 0.03). MMSE scores did not change significantly over time (mean scores 24.4, 25.1, and 27.6 respectively, p < 0.13). Nine of 114 patients 70 years experienced grade 3 toxicity and no patients experienced grade 4 toxicity. Conclusions: Our preliminary data suggest that geriatric adults can tolerate GRS without a significant decline in KPS or MMSE, and experience acceptably low rates of treatment toxicity. These patients were not at an increased risk of neurologic death than younger patients. Further prospective trials will be needed to understand the implications for efficacy and quality of life in the geriatric population receiving GRS. Author Disclosure: D. Randolph: None. A.M. Peiffer: None. H. Klepin: None. D.N. Ayala-Peacock: None. S.C. Lester: None. A.W. Laxton: None. S.B. Tatter: None. E.G., Shaw: None. M.D. Chan: None.
3062 Functional Outcomes and Quality of Life After Definitive Chemoradiation for Human Papillomavirus-Positive Oropharyngeal Cancer: Implications for Dose De-escalation A.M. Chen, M.E. Daly, G. Farwell, Q. Luu, P.J. Donald, and A.T. Vaughan; University of California Davis Comprehensive Cancer Center, Sacramento, CA Purpose/Objective(s): Studies have consistently shown excellent rates of disease control among patients with human papillomavirus (HPV)-associated oropharyngeal cancer treated with chemoradiation. However, limited data describes functional outcomes and quality of life for this population, which is particularly relevant given that long-term survival is common. Materials/Methods: Sixty-three consecutive patients with stage III/IV, p16-positive squamous cell carcinoma of the oropharynx treated by definitive radiation therapy with concurrent cisplatin chemotherapy formed the study population. All patients were disease-free and had at least 1 year of follow-up. Clinical T-stages were: T1 20%; T2 26%, T3 30%, T4 24%. Treatment was delivered with conventionally fractionated radiation to a median total dose of 70 Gy (range, 63 to 72 Gy). Fifty-two patients had formal speech and swallow evaluation at a median of 6-months after completion of therapy, with 40 patients undergoing esophagoscopy and/or dynamic fluoroscopy. The University of Washington Quality of Life instrument (UW-QOL) scores were reviewed at 1-, 2-, and 3-years after chemoradiation and compared to pre-treatment levels. The domain scores for self-reported global quality of life, activity, swallowing, chewing, speech, shoulder function, taste, salivary function, mood, and anxiety were assessed to identify statistical trends. Changes in mean scores were evaluated on an exploratory basis with repeated measurement analysis of variance (ANOVA). Results: The proportion of patients rating their global quality of life as “poor” or “very poor” at 1-, 2-, and 3-years after completion of chemoradiation was 30%, 25%, and 21%, respectively, which represented significant increases from baseline (p < 0.05). At last follow-up, 49% of patients reported salivary function “of normal consistency” or “less saliva than normal, but enough.” Only 13% and 20% of patients reported a subjectively “normal” swallow at 1- and 2-years with the corresponding rates of gastrostomy-tube dependence being 11% and 5%. Late swallowing abnormalities diagnosed after treatment included esophageal stricture (14 patients), chronic aspiration (5 patients), and epiglottic dysmotility (5 patients). Other observed complications included osteoradionecrosis, chronic lymphedema, and laryngeal edema. Conclusions: Significant treatment-related morbidity was observed among long-term survivors of HPV-associated oropharyngeal cancer treated with chemoradiation, resulting in compromised function and quality of life. Ongoing attempts to de-escalate treatment intensity while maintaining efficacy on carefully designed clinical trials seem appropriate. Author Disclosure: A.M. Chen: None. M.E. Daly: None. G. Farwell: None. Q. Luu: None. P.J. Donald: None. A.T. Vaughan: None.
3063 Qualitative and Quantitative Distress Assessment of Cancer Patients Using the NCCN Distress Thermometer D. Boothe,1 J. Waller,2 Y. Chen,3 S. Hedlund,4 and C.R. Thomas5; 1Weill Cornell Medical College, New York, NY, 2Department of Radiation Oncology, Oregon Health Sciences University, Portland, OR, 3Department of Public Health and Preventative Medicine, Oregon Health Sciences University, Portland, OR, 4Knight Cancer Institute, Oregon Health Sciences University, Portland, OR, 5Department of Radiation Oncology, Oregon Health Sciences University, Portland, OR Purpose/Objective(s): The specific aims were to investigate the prevalence and contributing psychological factors of distress among cancer patients (pts) treated with radiation therapy (RT), and to determine the relationship between these symptoms and treatment site.
Volume 87 Number 2S Supplement 2013 were general activity (60%) and mood (60%). Meaningful improvements were reported by 31% (mean score 4.35, SD 3.12) and 32% (mean score 3.85, SD 2.9) of these patients respectively. Among all patients, the most commonly reported instances of worsened QOL were drowsiness (33.3%) and dry mouth (32.4%). For the entire cohort, a median of 33% (17%56%) of symptomatic patients reported meaningful improvements when considering all domains together, while 24% (5%-32%) reported worsening QOL (p < 0.0001). There were no significant differences in MDASISP outcomes whether single fraction or hypofractionated SRS was given. Conclusions: The current analysis showed that in the majority of patients the QOL improved or showed no significant change after SRS. The lack of decline in the QOL is consistent with prevention of symptomatic tumor progression due to the effective tumor control provided by SRS and the lack of meaningful toxicity. Long-term follow-up data will be required in order to delineate the risk factors for QOL decline after SRS. Author Disclosure: Y. Yamada: F. Honoraria; Institute for Medical Education. G. Consultant; Varian Medical Systems. H. Travel Expenses; American Brachytherapy Society. T. Tam: None. T. Atkinson: None. L. Friguglietti: None. I. Laufer: None. J. Zatcky: None. M. Bilsky: None.
3061 Impact of Radiosurgical Management of Geriatric Patients With Brain Metastases: Clinical and Quality of Life Outcomes D. Randolph, A.M. Peiffer, H. Klepin, D.N. Ayala-Peacock, S.C. Lester, A.W. Laxton, S.B. Tatter, E.G. Shaw, and M.D. Chan; Wake Forest Baptist Medical Center, Winston Salem, NC Purpose/Objective(s): Recent trials have shown that whole brain radiation therapy (WBRT) can worsen performance status, particularly in the geriatric population. We reviewed our institutional experience with geriatric patients ( 70 years) with brain metastases treated with gamma radiosurgery (GRS) to determine if geriatric patients have any different clinical outcomes than younger patients, and to assess quality of life measures in the elderly after GRS. Materials/Methods: Between 7/2000 and 1/2013, a retrospective review was performed on a total of 468 patients treated with GRS (N Z 114 patients 70, N Z 354 <70 years). Clinical outcomes were overall survival (OS), cause of death, and subsequent whole brain radiation (WBRT). A subset of geriatric patients were prospectively followed with assessments of Karnofsky performance score (KPS, N Z 69), mini-mental status examinations (MMSE, N Z 39), and Spitzer quality of life assessments (N Z 39) at initial interview, 6 months, and 12 months after GRS. Repeated Measures ANOVA was used to evaluate differences in longitudinal quality of life values. Kaplan-Meier analysis was used to estimate survival and time to WBRT. Results: Patients 70 years had a shorter OS compared to younger patients (median 6 vs 8 months, p < 0.035). Fewer patients in the 70 cohort received whole brain (11.4% vs 30.8%, p < 0.001) or subsequent GRS (15.8% vs 26.3%, p < 0.025) as compared to younger patients. No difference was seen between the population <70 and 70 in cause of death, (<70 vs 70, neurologic death 29.1% vs 27.2% respectively, p < 0.4). Among available geriatric patients, KPS was not statistically different in the geriatric population between 0, 6, or 12 months after GRS. Spitzer scores declined from 0 to 6 months (mean 10.7 and 5.4 respectively, p < 0.02) and 0 to 12 months (mean 10.7 and 5.6, respectively, p < 0.03). MMSE scores did not change significantly over time (mean scores 24.4, 25.1, and 27.6 respectively, p < 0.13). Nine of 114 patients 70 years experienced grade 3 toxicity and no patients experienced grade 4 toxicity. Conclusions: Our preliminary data suggest that geriatric adults can tolerate GRS without a significant decline in KPS or MMSE, and experience acceptably low rates of treatment toxicity. These patients were not at an increased risk of neurologic death than younger patients. Further prospective trials will be needed to understand the implications for efficacy and quality of life in the geriatric population receiving GRS. Author Disclosure: D. Randolph: None. A.M. Peiffer: None. H. Klepin: None. D.N. Ayala-Peacock: None. S.C. Lester: None. A.W. Laxton: None. S.B. Tatter: None. E.G., Shaw: None. M.D. Chan: None.
3062 Functional Outcomes and Quality of Life After Definitive Chemoradiation for Human Papillomavirus-Positive Oropharyngeal Cancer: Implications for Dose De-escalation A.M. Chen, M.E. Daly, G. Farwell, Q. Luu, P.J. Donald, and A.T. Vaughan; University of California Davis Comprehensive Cancer Center, Sacramento, CA Purpose/Objective(s): Studies have consistently shown excellent rates of disease control among patients with human papillomavirus (HPV)-associated oropharyngeal cancer treated with chemoradiation. However, limited data describes functional outcomes and quality of life for this population, which is particularly relevant given that long-term survival is common. Materials/Methods: Sixty-three consecutive patients with stage III/IV, p16-positive squamous cell carcinoma of the oropharynx treated by definitive radiation therapy with concurrent cisplatin chemotherapy formed the study population. All patients were disease-free and had at least 1 year of follow-up. Clinical T-stages were: T1 20%; T2 26%, T3 30%, T4 24%. Treatment was delivered with conventionally fractionated radiation to a median total dose of 70 Gy (range, 63 to 72 Gy). Fifty-two patients had formal speech and swallow evaluation at a median of 6-months after completion of therapy, with 40 patients undergoing esophagoscopy and/or dynamic fluoroscopy. The University of Washington Quality of Life instrument (UW-QOL) scores were reviewed at 1-, 2-, and 3-years after chemoradiation and compared to pre-treatment levels. The domain scores for self-reported global quality of life, activity, swallowing, chewing, speech, shoulder function, taste, salivary function, mood, and anxiety were assessed to identify statistical trends. Changes in mean scores were evaluated on an exploratory basis with repeated measurement analysis of variance (ANOVA). Results: The proportion of patients rating their global quality of life as “poor” or “very poor” at 1-, 2-, and 3-years after completion of chemoradiation was 30%, 25%, and 21%, respectively, which represented significant increases from baseline (p < 0.05). At last follow-up, 49% of patients reported salivary function “of normal consistency” or “less saliva than normal, but enough.” Only 13% and 20% of patients reported a subjectively “normal” swallow at 1- and 2-years with the corresponding rates of gastrostomy-tube dependence being 11% and 5%. Late swallowing abnormalities diagnosed after treatment included esophageal stricture (14 patients), chronic aspiration (5 patients), and epiglottic dysmotility (5 patients). Other observed complications included osteoradionecrosis, chronic lymphedema, and laryngeal edema. Conclusions: Significant treatment-related morbidity was observed among long-term survivors of HPV-associated oropharyngeal cancer treated with chemoradiation, resulting in compromised function and quality of life. Ongoing attempts to de-escalate treatment intensity while maintaining efficacy on carefully designed clinical trials seem appropriate. Author Disclosure: A.M. Chen: None. M.E. Daly: None. G. Farwell: None. Q. Luu: None. P.J. Donald: None. A.T. Vaughan: None.
3063 Qualitative and Quantitative Distress Assessment of Cancer Patients Using the NCCN Distress Thermometer D. Boothe,1 J. Waller,2 Y. Chen,3 S. Hedlund,4 and C.R. Thomas5; 1Weill Cornell Medical College, New York, NY, 2Department of Radiation Oncology, Oregon Health Sciences University, Portland, OR, 3Department of Public Health and Preventative Medicine, Oregon Health Sciences University, Portland, OR, 4Knight Cancer Institute, Oregon Health Sciences University, Portland, OR, 5Department of Radiation Oncology, Oregon Health Sciences University, Portland, OR Purpose/Objective(s): The specific aims were to investigate the prevalence and contributing psychological factors of distress among cancer patients (pts) treated with radiation therapy (RT), and to determine the relationship between these symptoms and treatment site.