ABSTRACT
PURPOSE: Stereotactic radiosurgery (SRS) of brain metastasis in patients with a poor prognosis remains controversial. Here, we compared results of SRS alone to whole brain radiotherapy (WBRT) in poor-prognosis patients and defined the most important unfavorable prognostic factors related to early death after SRS alone. PATIENTS AND METHODS: In this retrospective analysis of prospective SRS data, 180 patients with brain metastases not previously treated with WBRT were analyzed. Results of SRS were compared to WBRT by propensity score matching in patients with a poor prognosis defined by graded prognostic assessment (GPA) <2. Further, SRS patients were divided into training (n=82) and validation (n=48) cohorts. Overall survival (OS) and the risk of early death were defined by univariable and multivariable analyses. RESULTS: Median survival of the WBRT and SRS cohorts was 86 days (IQR: 38-172 days) and 201 days (IQR: 86-not reached), respectively (p<0.0001). OS in patients with GPA<2 was significantly longer in the SRS vs WBRT group (123 vs 58 days; p=0.008). Survival was longer in the SRS group in a propensity score matched analysis. In multivariable analysis, GPA (OR: 0.44, 95%CI: 0.21-0.95; p=0.001), extensive extracranial disease (OR: 0.13, 95%CI: 0.02-0.66; p=0.013), and serious neurological deficits (OR: 0.13, 95%CI: 0.04-0.45; p=0.001) were associated with early death. If one factor was favorable, 73% (training) and 92% (validation) of patients survived three months. Patients with GPA <2 presenting with serious neurological deficits and extensive extracranial disease had a low expected benefit due to the highest risk of death within three months (AUC: 0.822 training; 0.932 validation). CONCLUSION: SRS is a viable treatment option for patients with a poor prognosis defined as GPA <2. Good neurological status, extracranial oligometastatic disease, or GPA ≥2 should be present to justify SRS in patients with brain metastases.
ABSTRACT
BACKGROUND: Rehabilitation therapy in children with neuromotor development disorders can be carried out with the use of various methods. OBJECTIVES: The aim of this study was to determine the efficiency of rehabilitation carried out with the use of the new therapeutic method MNRI (Masgutova Neurosensorimotor Reflex Integration) in children with cerebral palsy (CP) by objective measurements with a brainstem auditory evoked potentials (BAEP) examination. MATERIAL AND METHODS: Besides the known parameters, Interpeak Latency I-V (IPL I-V) in BAEP, an original parameter proposed by Pilecki was introduced, called a relative IPL I-V value. The study involved a group of 17 children (9 girls and 8 boys) aged from 1.3 to 5.9 years (mean = 3.8 years, SD = 1.3) with cerebral palsy. Due to difficulty in co-operation, analysis of only 15 children could be finished. RESULTS: Analysis of the absolute IPL I-V values showed that after rehabilitation the percentage of the results with slowed transmission, i.e. those in which the IPL I-V value was prolonged, decreased from more than 88% to 60%. The assessment of the relative IPL I-V values showed that the results obtained after rehabilitation are more advantageous. CONCLUSIONS: As a result of rehabilitation carried out by the MNRI method in children with CP, a significant improvement in the transmission in the brain stem section of the auditory pathway was observed based on the absolute and relative IPL I-V values. However, the change obtained in children was various.
