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Heart Rate Variability as a Novel Prognosticator in Patients With Brain Metastasis: A Pilot Study
Poster Viewing Abstracts S697
Volume 90 Number 1S Supplement 2014 Wolinsky: None. C. Bettegowda: None. D. Sciubba: None. Z. Gokaslan: None. S. Grossman: None. L. Kleinberg: None. K.J. Redmond: None.
3237 Analysis of Factors Complicating Treatment for Bone Metastases: Why Are Patients Not Receiving Single-Fraction Radiation Therapy? S.R. Alcorn,1 S. Saleemi,2 P. Perng,2 T.R. McNutt,3 R.K. Hales,1 T.L. DeWeese,4 T.J. Smith,1 and S. Ellsworth1; 1Johns Hopkins Hospital, Baltimore, MD, 2Johns Hopkins School of Medicine, Baltimore, MD, 3 Johns Hopkins University, Baltimore, MD, 4Johns Hopkins University School of Medicine, Baltimore, MD Purpose/Objective(s): Although prospective studies and national guidelines support the use of short fractionation schemes for the treatment of uncomplicated bone metastases with radiation therapy (RT), the optimal management of patients with complicated metastases remains unclear. Moreover, there is little consensus on what features define a complicated metastasis. We evaluate the rates of several potential complicating features among patients treated for bone metastases at a high-volume center. Materials/Methods: Electronic medical records identified palliative bone RT plans between 9/2007- 7/2012. Demographic and RT characteristics were collected. Diagnostic radiology reports and images as well as all RT planning images and treatment plans were evaluated to identify complicating features within the RT field: prior RT, prior surgery, actual or impending fracture, epidural extension, spinal cord compression with cord edema, neuraxis (spinal canal and/or neuroforaminal) stenosis, or soft tissue extension. Results: A total of 647 RT plans for 366 patients were analyzed. Median age was 63 years (range 22-94), with a median of 22 months (range 0-351) from initial diagnosis to RT consultation. Primary tumors were 19% breast, 15% prostate, 30% lung, and 36% other, and RT plans were 50% spine, 21% pelvis, 17% extremities, and 12% other. The table below describes rates of complicating features. Lesions affecting bone alone without soft tissue or epidural extension comprised 38% of plans; excluding prior RT, prior surgery, and/or impending or actual fracture, such bone-only lesions accounted for 27% of all cases. For spine plans, 18% were complicated by prior RT, prior surgery, and/or cord compression; this increased to 43% if fracture was added, 69% if neuraxis stenosis and/or epidural extension were then added, and 80% if all of the above plus soft tissue extension were included. Conclusions: Uncomplicated bone metastases suitable for single-fraction RT comprise less than 1/3 of cases; the remainder have complicating features that may require more complex regimens. Comparison of RT patterns of care across health systems should take into account the presence of complications that may limit the use of short fractionation schemes. Scientific Abstract 3237; Table metastases
All sites –Prior RT –Prior surgery –Actual or impending fracture –Soft tissue extension Spine sites –Epidural extension –Neuraxis stenosis –Cord compression
Rates of complicating features for bone N
Percent
23 56 159 251
4 9 27 44
117 171 15
43 53 5
Author Disclosure: S.R. Alcorn: A. Employee; Johns Hopkins Hospital. S. Saleemi: None. P. Perng: None. T.R. McNutt: A. Employee; Johns Hopkins Hospital. R.K. Hales: A. Employee; Johns Hopkins Hospital. T.L. DeWeese: A. Employee; Johns Hopkins Hospital. T.J. Smith: A. Employee; Johns Hopkins Hospital. S. Ellsworth: A. Employee; Johns Hopkins Hospital.
3238 Heart Rate Variability as a Novel Prognosticator in Patients With Brain Metastasis: A Pilot Study Y. Wang,1,2 H. Wu,3 E. Huang,2 C. Wang,2 S. Hseu,4 and Y. Kou1; 1 Institute of Physiology, National Yang-Ming University, Taipei, Taiwan, 2 Department of Radiation Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 3Department of Mathematics, Stanford University, Stanford, CA, 4 Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan Purpose/Objective(s): Impaired heart rate variability (HRV) has been demonstrated with poor survival in various diseases. However, the relationship between HRV and survival in patients with brain metastasis (BM) remains unclear. We conducted this study to evaluate the impact of HRV for survival in patients with BM. Materials/Methods: This prospective study was conducted since January 2010. Patients with BM referred for palliative whole brain radiation therapy (WBRT) without prior CNS/Chest surgery and irradiation were recruited. Those who were taking medications for hypertension, cardiac arrhythmia, and taking sedatives were excluded. A 5-minute ECG was recorded for every participant before the start of WBRT and time domain methods were used for HRV analysis. All patients underwent WBRT via traditional helmet-field using 6-MV or 10-MV photon for 30 - 37.5 Gy in 10 - 15 daily fractions. Patients had regular follow-up until their death. The primary end-point was overall survival. Kaplan-Meier method was used for survival analysis. Prognostic factors were compared by log-rank test. Multivariate analysis was conducted using the Cox’s proportional hazard regression method for all factors. Results: Between January 2010 and October 2012, 67 patients were first recruited. Thirteen patients (19%) were excluded for following analysis due to > 1% ectopic beats, thus 54 patients were included for this study. The median age among these patients were 60 years old (30 - 78) and median KPS was 70 (30 - 90). The most common primary origin was NSCLC (33 / 54) followed by SCLC (6 / 54) and breast cancer (6 / 54). For HRV indices, the median mean heart rate was 86 beat-per-minutes (range: 53 - 118). Median SDNN and RMSSD were 14.5 ms (range: 1 - 46) and 9.5 ms (range: 2 - 58), respectively. Until the day we perform the analysis, eight patients were alive. The median survival time was 3.96 months for all patients and 11.16 months for the survivors. Univariate analysis revealed that SDNN 10 ms (p Z 0.004) and KPS 70 (p < 0.001) were significant prognosticators for OS. The corresponding 3-months/6-month survival rate were 38.9%/ 27.8% and 63.9%/52.5% for patients with SDNN < 10 ms and SDNN 10 ms. Multivariate analysis confirmed that independent prognosticators for OS in our patients were SDNN 10 ms (p Z 0.014) and KPS 70 (p Z 0.001). Conclusions: HRV, primary the time domain index SDNN, is a novel independent prognosticator for survival in patients with BM. Further study is warranted to evaluate the clinical use of HRV in risk stratification for BM patients. Author Disclosure: Y. Wang: None. H. Wu: None. E. Huang: None. C. Wang: None. S. Hseu: None. Y. Kou: None.
3239 Adverse Outcomes After Palliative Radiation Therapy for Uncomplicated Spine Metastases: Role of Spinal Instability and Single-Fraction Radiation Therapy T. Lam,1 H. Uno,2 M.S. Krishnan,3 M. Cheney,4 and T.A. Balboni1; 1 Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, 2Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, 3 Department of Radiation Oncology Dana-Farber/South Shore Hospital, Boston, MA, 4Harvard Radiation Oncology Program, Boston, MA
Volume 90 Number 1S Supplement 2014 Wolinsky: None. C. Bettegowda: None. D. Sciubba: None. Z. Gokaslan: None. S. Grossman: None. L. Kleinberg: None. K.J. Redmond: None.
3237 Analysis of Factors Complicating Treatment for Bone Metastases: Why Are Patients Not Receiving Single-Fraction Radiation Therapy? S.R. Alcorn,1 S. Saleemi,2 P. Perng,2 T.R. McNutt,3 R.K. Hales,1 T.L. DeWeese,4 T.J. Smith,1 and S. Ellsworth1; 1Johns Hopkins Hospital, Baltimore, MD, 2Johns Hopkins School of Medicine, Baltimore, MD, 3 Johns Hopkins University, Baltimore, MD, 4Johns Hopkins University School of Medicine, Baltimore, MD Purpose/Objective(s): Although prospective studies and national guidelines support the use of short fractionation schemes for the treatment of uncomplicated bone metastases with radiation therapy (RT), the optimal management of patients with complicated metastases remains unclear. Moreover, there is little consensus on what features define a complicated metastasis. We evaluate the rates of several potential complicating features among patients treated for bone metastases at a high-volume center. Materials/Methods: Electronic medical records identified palliative bone RT plans between 9/2007- 7/2012. Demographic and RT characteristics were collected. Diagnostic radiology reports and images as well as all RT planning images and treatment plans were evaluated to identify complicating features within the RT field: prior RT, prior surgery, actual or impending fracture, epidural extension, spinal cord compression with cord edema, neuraxis (spinal canal and/or neuroforaminal) stenosis, or soft tissue extension. Results: A total of 647 RT plans for 366 patients were analyzed. Median age was 63 years (range 22-94), with a median of 22 months (range 0-351) from initial diagnosis to RT consultation. Primary tumors were 19% breast, 15% prostate, 30% lung, and 36% other, and RT plans were 50% spine, 21% pelvis, 17% extremities, and 12% other. The table below describes rates of complicating features. Lesions affecting bone alone without soft tissue or epidural extension comprised 38% of plans; excluding prior RT, prior surgery, and/or impending or actual fracture, such bone-only lesions accounted for 27% of all cases. For spine plans, 18% were complicated by prior RT, prior surgery, and/or cord compression; this increased to 43% if fracture was added, 69% if neuraxis stenosis and/or epidural extension were then added, and 80% if all of the above plus soft tissue extension were included. Conclusions: Uncomplicated bone metastases suitable for single-fraction RT comprise less than 1/3 of cases; the remainder have complicating features that may require more complex regimens. Comparison of RT patterns of care across health systems should take into account the presence of complications that may limit the use of short fractionation schemes. Scientific Abstract 3237; Table metastases
All sites –Prior RT –Prior surgery –Actual or impending fracture –Soft tissue extension Spine sites –Epidural extension –Neuraxis stenosis –Cord compression
Rates of complicating features for bone N
Percent
23 56 159 251
4 9 27 44
117 171 15
43 53 5
Author Disclosure: S.R. Alcorn: A. Employee; Johns Hopkins Hospital. S. Saleemi: None. P. Perng: None. T.R. McNutt: A. Employee; Johns Hopkins Hospital. R.K. Hales: A. Employee; Johns Hopkins Hospital. T.L. DeWeese: A. Employee; Johns Hopkins Hospital. T.J. Smith: A. Employee; Johns Hopkins Hospital. S. Ellsworth: A. Employee; Johns Hopkins Hospital.
3238 Heart Rate Variability as a Novel Prognosticator in Patients With Brain Metastasis: A Pilot Study Y. Wang,1,2 H. Wu,3 E. Huang,2 C. Wang,2 S. Hseu,4 and Y. Kou1; 1 Institute of Physiology, National Yang-Ming University, Taipei, Taiwan, 2 Department of Radiation Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 3Department of Mathematics, Stanford University, Stanford, CA, 4 Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan Purpose/Objective(s): Impaired heart rate variability (HRV) has been demonstrated with poor survival in various diseases. However, the relationship between HRV and survival in patients with brain metastasis (BM) remains unclear. We conducted this study to evaluate the impact of HRV for survival in patients with BM. Materials/Methods: This prospective study was conducted since January 2010. Patients with BM referred for palliative whole brain radiation therapy (WBRT) without prior CNS/Chest surgery and irradiation were recruited. Those who were taking medications for hypertension, cardiac arrhythmia, and taking sedatives were excluded. A 5-minute ECG was recorded for every participant before the start of WBRT and time domain methods were used for HRV analysis. All patients underwent WBRT via traditional helmet-field using 6-MV or 10-MV photon for 30 - 37.5 Gy in 10 - 15 daily fractions. Patients had regular follow-up until their death. The primary end-point was overall survival. Kaplan-Meier method was used for survival analysis. Prognostic factors were compared by log-rank test. Multivariate analysis was conducted using the Cox’s proportional hazard regression method for all factors. Results: Between January 2010 and October 2012, 67 patients were first recruited. Thirteen patients (19%) were excluded for following analysis due to > 1% ectopic beats, thus 54 patients were included for this study. The median age among these patients were 60 years old (30 - 78) and median KPS was 70 (30 - 90). The most common primary origin was NSCLC (33 / 54) followed by SCLC (6 / 54) and breast cancer (6 / 54). For HRV indices, the median mean heart rate was 86 beat-per-minutes (range: 53 - 118). Median SDNN and RMSSD were 14.5 ms (range: 1 - 46) and 9.5 ms (range: 2 - 58), respectively. Until the day we perform the analysis, eight patients were alive. The median survival time was 3.96 months for all patients and 11.16 months for the survivors. Univariate analysis revealed that SDNN 10 ms (p Z 0.004) and KPS 70 (p < 0.001) were significant prognosticators for OS. The corresponding 3-months/6-month survival rate were 38.9%/ 27.8% and 63.9%/52.5% for patients with SDNN < 10 ms and SDNN 10 ms. Multivariate analysis confirmed that independent prognosticators for OS in our patients were SDNN 10 ms (p Z 0.014) and KPS 70 (p Z 0.001). Conclusions: HRV, primary the time domain index SDNN, is a novel independent prognosticator for survival in patients with BM. Further study is warranted to evaluate the clinical use of HRV in risk stratification for BM patients. Author Disclosure: Y. Wang: None. H. Wu: None. E. Huang: None. C. Wang: None. S. Hseu: None. Y. Kou: None.
3239 Adverse Outcomes After Palliative Radiation Therapy for Uncomplicated Spine Metastases: Role of Spinal Instability and Single-Fraction Radiation Therapy T. Lam,1 H. Uno,2 M.S. Krishnan,3 M. Cheney,4 and T.A. Balboni1; 1 Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, 2Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, 3 Department of Radiation Oncology Dana-Farber/South Shore Hospital, Boston, MA, 4Harvard Radiation Oncology Program, Boston, MA