Session Item

The prognostic assessment of patients referred for palliative radiotherapy can be conducted by different methods, including site-specific scores, e.g. for brain metastases (DS-GPA) and bone metastases (BMETS), or the TEACHH model. A relatively simple and quick assessment that would cover the whole spectrum of palliative radiotherapy could simplify the working day of clinicians who are not specialists for a particular disease site. Moreover, elimination of parameters that vary between different healthcare systems (barriers/access to in-patient care, access to certain types of systemic therapy etc.) may facilitate the international applicability of a score. The purpose of this study was to evaluate the site-agnostic, biomarker-based LabBM score (developed and validated for brain metastases and recently studied in patients irradiated for non-brain targets (DOI: 10.5603/RPOR.a2021.0096)), in its refined version that incorporates performance status (LabPS).     

The score was calculated as originally described, i.e. by assigning 1 point each for C-reactive protein and lactate dehydrogenase above the upper institutional limit of normal, and 0.5 points each for hemoglobin, platelets and albumin below the lower institutional limit of normal. ECOG performance status was stratified into 3-4 (1 point), 2 (0.5 points) and 0-1 (0 points). A lower point sum indicates a better prognosis. Uni- and multivariate analyses were performed. Overall, 375 consecutive patients without brain metastases were studied (for those with brain metastases the LabPS score has already been published in Am J Clin Oncol 2021, DOI: 10.1097/COC.0000000000000784.).         

Common tumor types included prostate, lung or breast cancer. Both, primary and re-irradiation was included (bone, lymphatic, lung metastases and other targets). Often, 8 Gy x1, 4 Gy x5 or 3 Gy x10 was employed. Median overall survival gradually decreased with increasing point sum (range 26.5-0.6 months, p<0.001, Figure 1). When grouped according to the original three-tiered variant, excellent discrimination was found. All patients with the highest point sum (characterized by ECOG PS 3-4 and 5 abnormal biomarkers) died within 35 days from start of palliative radiotherapy. All patients with the lowest point sum (ECOG PS 0-1, all 5 biomarkers normal) survived for at least 6 months. 

The LabPS score, which is derived from inexpensive blood tests and easy to use, stratified patients irradiated for indications other than brain metastases into distinct prognostic groups and deserves further validation.