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KPS/LDH index: a simple tool for identifying patients with metastatic melanoma who are unlikely to benefit from palliative whole brain radiotherapy

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Abstract

Purpose

Low Karnofsky performance status (KPS) and elevated lactate dehydrogenases (LDHs) as a surrogate marker for tumor load and cell turnover may depict patients with a very short life expectancy. To validate this finding and compare it to other indices, namely, the recursive partitioning analysis (RPA) and diagnosis-specific graded prognostic assessment (DS-GPA), a multicenter analysis was undertaken.

Methods

A retrospective analysis of 234 metastatic melanoma patients uniformly treated with palliative whole brain radiotherapy (WBRT) was done. Univariate and multivariate analyses were used to determine the impact of patient-, tumor-, and treatment-related parameters on overall survival (OS).

Results

KPS and LDH emerged as independent factors predicting OS. By combining KPS and LDH values (KPS/LDH index), groups of patients with statistically significant differences in median OS (days; 95 % CI) after onset of WBRT were identified: group 1 (KPS ≥70/normal LDH) 234 (96–372), group 2 (KPS ≥70/elevated LDH) 112 (69–155), group 3 (KPS <70/normal LDH) 43 (12–74), and group 4 (KPS <70/elevated LDH) 29 (17–41). Between all four groups, statistically significant differences were observed. The RPA and DS-GPA indices failed to distinguish significantly between good and moderate prognosis and were inferior in predicting a very unfavorable prognosis.

Conclusions

The parameters KPS and LDH independently impacted on OS. The combination of both (KPS/LDH index) identified patients with a very short life expectancy, who might be better served by recommending best supportive care instead of WBRT. The KPS/LDH index is simple and effective in terms of time and cost as compared to other prognostic indices.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Therapeutic Radiology and Oncology, Medical University Graz, Comprehensive Cancer Center Graz, Auenbruggerplatz 32, 8036, Graz, Austria

    Richard Partl

  2. Department of Radiotherapy and Radio-Oncology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, 5020, Austria

    Gerd Fastner & Julia Kaiser

  3. Institute of Radiooncology, General Hospital, Wr. Neustadt, Vienna, 2700, Austria

    Elisabeth Kronhuber & Klaudia Cetin-Strohmer

  4. Institute of Radiooncology, Kaiser-Franz-Josef-Spital, Vienna, 1100, Austria

    Claudia Steffal

  5. Department of Radiooncology, Krems Hospital, Vienna, 3530, Austria

    Barbara Böhmer-Breitfelder & Johannes Mayer

  6. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Comprehensive Cancer Center Graz, Graz, 8036, Austria

    Alexander Avian & Andrea Berghold

Authors
  1. Richard Partl
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  2. Gerd Fastner
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  3. Julia Kaiser
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  4. Elisabeth Kronhuber
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  5. Klaudia Cetin-Strohmer
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  6. Claudia Steffal
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  7. Barbara Böhmer-Breitfelder
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  8. Johannes Mayer
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  9. Alexander Avian
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  10. Andrea Berghold
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Correspondence to Richard Partl.

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Partl, R., Fastner, G., Kaiser, J. et al. KPS/LDH index: a simple tool for identifying patients with metastatic melanoma who are unlikely to benefit from palliative whole brain radiotherapy. Support Care Cancer 24, 523–528 (2016). https://doi.org/10.1007/s00520-015-2793-7

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  • DOI: https://doi.org/10.1007/s00520-015-2793-7

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