Proxy assessment of patients before and after radiotherapy for brain metastases. Results of a prospective study using the DEGRO brain module

PURPOSE

Proxies of patients with poor performance status could give useful information about the patients' quality of life (QoL). We applied a newly developed questionnaire in a prospective QoL study of patients undergoing radiotherapy for brain metastases in order to make the first move to validate this instrument, and we compared the results with scores obtained using validated patient-completed instruments.

MATERIALS AND METHODS

From January 2007 to June 2010,  166 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. The EORTC-QLQ-C15-PAL and the brain module BN20 were used to assess QoL in patients at the start of treatment and 3 months later. At the same time points, 141 of their proxies estimated the QoL with the new DEGRO brain module (DBM), a ten-item questionnaire rating the general condition as well as functions and impairment by symptoms in areas relevant to patients with brain metastases.

RESULTS

At 3 months, 85 of 141 patients (60%) with initial response by a proxy were alive. Sixty-seven of these patients (79% of 3-month survivors) and 65 proxies completed the second set of questionnaires. After 3 months, QoL significantly deteriorated in all items of proxy-assessed QoL except headache. Correlations between self-assessed and proxy-assessed QoL were high in single items such as nausea, headache, and fatigue.

CONCLUSIONS

The high correlation between self-assessment and proxy ratings as well as a similar change over time for both approaches suggest that in patients with brain metastases, proxy assessment using the DBM questionnaire can be an alternative approach to obtaining QoL data when patients are unable to complete questionnaires themselves. Our self-constructed and first applied DBM is the only highly specific instrument for patients with brain metastases, but further tests are needed for its final validation.

Immune depression syndrome following human spinal cord injury (SCI): a pilot study

Experimental spinal cord injury (SCI) has been identified to trigger a systemic, neurogenic immune depression syndrome. Here, we have analyzed fluctuations of immune cell populations following human SCI by FACS analysis. In humans, a rapid and drastic decrease of CD14+ monocytes (<50% of control level), CD3+ T-lymphocytes (<20%, P<0.0001) and CD19+ B-lymphocytes (<30%, P=0.0009) and MHC class II (HLA-DR)+ cells (<30%, P<0.0001) is evident within 24 h after spinal cord injury reaching minimum levels within the first week. CD15+ granulocytes were the only leukocyte subpopulation not decreasing after SCI. A contributing, worsening effect of high dose methylprednisolone cannot be excluded with this pilot study. We demonstrate that spinal cord injury is associated with an early onset of immune suppression and secondary immune deficiency syndrome (SCI-IDS). Identification of patients suffering spinal cord injury as immune compromised is a clinically relevant, yet widely underappreciated finding.

[Experiences with intraoperative autotransfusion in the replacement of hip endoprostheses]

This is a report about the use of the Haemonetic Cell Saver for intraoperative retransfusion of blood in replacement of total hip prostheses. The amount of donor blood used was compared in two groups of patients: group II, using the Cell Saver, group I without it. In group II, there was an average of 1000 ml less donor blood used; in certain individual cases, more blood was used. Using the patient's own blood reduces the postoperative reduction of hemoglobin content in the blood by 0.5 g%.

[Long-term experience with brachial plexus anesthesia]

In this work we report on our experience of more than 11 000 cases of plexus anaesthesia in the eight years 1976-1983. Particular care is taken to show how both the increase in experience and the amelioration in technology have led to an increase in the success rate. Our initial and current methods of axillary plexus block are described in detail, as are the most important signs relevant to the placing of the needle. Finally we discuss indications and contraindications, as well as possible complications and their prevention.