NUTRISCORE Compared to NRS-2002 for Detection of Malnutrition in Hospitalized Cancer Patients; A Cross Sectional Study.

The most commonly recommended screening test for determining the nutritional status of hospitalized cancer patients is Nutrition Risk Screening-2002 (NRS-2002). NUTRISCORE, on the other hand, is an outpatient cancer patient-specific nutritional screening test that is easier to administer than NRS-2002 and queries tumor location and treatment information received from the patient. We aimed to investigate the validity of NUTRISCORE, in hospitalized cancer patients. In total, 112 patients were enrolled in this study. The NRS 2002 and NUTRISCORE screening tests were performed. The data obtained with NUTRISCORE were compared to the reference test NRS-2002 using the κ test and ROC curve analysis. The NRS-2002 identified 45.5% of patients as being at risk of malnutrition, while the NUTRISCORE test identified 48.2% (k = 0.516, p < 0.005). The AUC value was 0.759 (95% CI:0.67-0.85) as shown in the ROC analysis. Using the NRS-2002 as a reference test, the sensitivity (S), specificity (SP), Positive Predictive (PPD), and Negative Predictive (NPD) values for the NUTRISCORE test were 76.5% (95% CI:63.7-86.6), 75.4% (95.CI:63.7-85), 72.2% (95% CI:59.4-83), 79%, (95% CI:67.7-88.3) respectively. NUTRISCORE can be used for screening of malnutrition in hospitalized cancer patients.

Gamma Knife Radiosurgery for Hemorrhagic Brainstem Cavernomas.

AIM: To assess treatment results of gamma knife radiosurgery (GKRS) for hemorrhagic brainstem cavernous malformations (BSCMs). MATERIAL AND METHODS: A retrospective review of patients with hemorrhagic BSCMs, who were treated at the Acibadem Kozyatagi Hospital GKRS unit from May 2007 to October 2015 was performed. RESULTS: In total, 82 patients were identified. All patients had experienced at least one hemorrhagic event (range 1-3), and all of them presented with radiological evidence of hemorrhage. The median target volume was 0.3 ml, and the median marginal radiation dose was 12 Gy. The mean durations before and after surgery were 25.5 (range 1-204) months, and 50.3 (range 13-113) months, respectively. Pre-treatment hemorrhage rates were calculated from the date of first hemorrhage to the date of radiosurgery. There were 97 bleeds over 174.4 patient-years during the observation period, with an annual hemorrhage rate of 55.7%. If the first bleed is excluded, the annual hemorrhage rate was 8.6%. Only three patients demonstrated re-bleeding, which occurred at 3, 12 and 79 months after radiosurgery. Over a total follow up time of 344 patient-years the annual re-bleeding rate was therefore 0.87%, indicating that the risk of BSCM hemorrhage was significantly decreased by radiosurgery. CONCLUSION: GKRS was a safe and effective treatment for symptomatic low volume BSCMs when a low marginal dose is used. A randomized controlled trial is needed that compares GKRS to observation if we want to establish the true efficacy of this treatment.

Gamma Knife Radiosurgery for Tumors of the Endolymphatic Sac.

Tumors of the endolymphatic sac are locally invasive temporal bone neoplasms. Radical surgical excision is the treatment of choice; however, the aggressive nature of these tumors can make total excision impossible. Recurrence is common in cases of incomplete resection. Gamma knife radiosurgery was used to treat two patients with primary tumors of the endolymphatic sac and one recurrent case. All three patients were alive at 75, 74, and 11 months, respectively, after gamma-knife treatment, and the tumors were either smaller or had not enlarged. None of the patients experienced radiation-related side effects during follow up. Gamma knife radiosurgery should be considered a treatment option for these surgically challenging tumors.

The benefit of whole brain reirradiation in patients with multiple brain metastases.

BACKGROUND: To assess the outcomes, symptom palliation and survival rates in patients who received repeat whole brain radiotherapy (WBRT). METHODS: Twenty-eight patients who had progression of brain metastasis received a second course of WBRT. Univariate log-rank testing and multivariate Cox regression analysis were used to determine the factors for death among several variables (cumulative BED [BEDcumulative], primary tumor site, Karnofsky performance scale [KPS], previous SRS, number of metastases and absence of extracranial metastases). Correlations between variables and treatment response were evaluated with the Chi-squared test. RESULTS: The median KPS was 60 (range 50 to 100) at the initiation of reirradiation. The median time interval between the two courses of WBRT was 9.5 months (range 3-27 months). The median doses of the first course and the second course of WBRT were 30 Gy (range 20 to 30 Gy) and 25 Gy (range 20 to 30 Gy), respectively. The mean BEDcumulative was 129.5 Gy (range 110 to 150 Gy). Severe or unexpected toxicity was not observed. Symptomatic response was detected in 39% of the patients. The median overall survival following reirradiation was 3 months (range 1 to 12 months, 95% CI 1.82-4.118). Survival was significantly better in responders (median 10 months, 95% CI 3.56-16.43) compared with non-responders (median 2 months, 95% CI 1.3-2.64) (p = 0.000). In multivariate analysis, patients that had lung cancer (p = 0.01), initial KPS ≥60 (p = 0.03) or longer intervals to reirradiation (p = 0.01) had significantly better survival rates. CONCLUSIONS: A careful second course of whole brain irradiation might provide a symptomatic and survival benefit in patients with good performance status and longer cranial progression-free intervals.