karnofsky performance status

Summary

Summary: A performance measure for rating the ability of a person to perform usual activities, evaluating a patient's progress after a therapeutic procedure, and determining a patient's suitability for therapy. It is used most commonly in the prognosis of cancer therapy, usually after chemotherapy and customarily administered before and after therapy. It was named for Dr. David A. Karnofsky, an American specialist in cancer chemotherapy.

Top Publications

  1. Aoyama H, Tago M, Kato N, Toyoda T, Kenjyo M, Hirota S, et al. Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys. 2007;68:1388-95 pubmed
    ..significant differences were observed for total tumor volume, extent of tumor edema, age, and Karnofsky performance status. Of the 92 patients who underwent the follow-up MMSE, 39 had a baseline MMSE score of < or =27 (17 ..
  2. Sperduto P, Chao S, Sneed P, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655-61 pubmed publisher
    ..For non-small-cell lung cancer and small-cell lung cancer, the significant prognostic factors were Karnofsky performance status, age, presence of extracranial metastases, and number of BMs, confirming the original GPA for these ..
  3. Wang Q, Deng J, Yuan J, Wang L, Zhao Z, He S, et al. Oncogenic reg IV is a novel prognostic marker for glioma patient survival. Diagn Pathol. 2012;7:69 pubmed publisher
    ..The virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/2145344361720706. ..
  4. Vermersch P, Kappos L, Gold R, Foley J, Olsson T, Cadavid D, et al. Clinical outcomes of natalizumab-associated progressive multifocal leukoencephalopathy. Neurology. 2011;76:1697-704 pubmed publisher
    ..These data suggest that earlier diagnosis through enhanced clinical vigilance and aggressive management may improve outcomes. ..
  5. Sperduto P, Kased N, Roberge D, Xu Z, Shanley R, Luo X, et al. Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys. 2012;82:2111-7 pubmed publisher
    ..Significant prognostic factors by multivariate Cox regression and RPA were Karnofsky performance status (KPS), HER2, ER/PR status, and the interaction between ER/PR and HER2...
  6. Anderson R, Kennedy B, Yanes C, Garvin J, Needle M, Canoll P, et al. Convection-enhanced delivery of topotecan into diffuse intrinsic brainstem tumors in children. J Neurosurg Pediatr. 2013;11:289-95 pubmed publisher
    ..403 mg in 6.04 ml over 100 hours. Her Karnofsky Performance Status (KPS) score was 60 before CED and 50 posttreatment...
  7. Knisely J, Yamamoto M, Gross C, Castrucci W, Jokura H, Chiang V. Radiosurgery alone for 5 or more brain metastases: expert opinion survey. J Neurosurg. 2010;113 Suppl:84-9 pubmed
    ..Given the substantial variation in clinicians' approaches to SRS use, further research is required to identify patient characteristics associated with optimal SRS outcomes. ..
  8. Li G, Zhang Z, Tu Y, Jin T, Liang H, Cui G, et al. Correlation of microRNA-372 upregulation with poor prognosis in human glioma. Diagn Pathol. 2013;8:1 pubmed publisher
  9. De Kock I, Mirhosseini M, Lau F, Thai V, Downing M, Quan H, et al. Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS), and the interchangeability of PPS and KPS in prognostic tools. J Palliat Care. 2013;29:163-9 pubmed
    The aim of our study was to assess whether the Karnofsky Performance Status (KPS), the Eastern Cooperative Oncology Group (ECOG) Performance Status, and the Palliative Performance Scale (PPS) are interchangeable individually or within two ..

Scientific Experts

More Information

Publications62

  1. Williams P, Schmideskamp J, Ridder E, Williams A. Symptom monitoring and dependent care during cancer treatment in children: pilot study. Cancer Nurs. 2006;29:188-97 pubmed
    ..The first 2 categories were the most used. Systematic assessment with a self-report checklist enables the provider to identify and prioritize (according to reported severity) those symptoms needing intervention. ..
  2. Forinder U, Löf C, Winiarski J. Quality of life following allogeneic stem cell transplantation, comparing parents' and children's perspective. Pediatr Transplant. 2006;10:491-6 pubmed
  3. McGirt M, Mukherjee D, Chaichana K, Than K, Weingart J, Quinones Hinojosa A. Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery. 2009;65:463-9; discussion 469-70 pubmed publisher
    ..Care should be taken to avoid surgically induced deficits in the management of GBM. ..
  4. Hadi S, Fan G, Hird A, Kirou Mauro A, Filipczak L, Chow E. Symptom clusters in patients with cancer with metastatic bone pain. J Palliat Med. 2008;11:591-600 pubmed publisher
    ..By treating a patient's symptom of worst pain, it would subsequently ease their response burden on their daily functional activities by decreasing symptom severity, increasing function, and improving overall quality of life. ..
  5. Tseng T, Cleeland C, Wang X, Lin C. Assessing cancer symptoms in adolescents with cancer using the Taiwanese version of the M. D. Anderson Symptom Inventory. Cancer Nurs. 2008;31:E9-16 pubmed publisher
    ..adolescent cancer patients with a low functional status and those with a high functional status (Karnofsky Performance Status scores <or= 80 and >80, respectively)...
  6. Rades D, Dunst J, Schild S. A new scoring system to predicting the survival of patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol. 2008;184:251-5 pubmed publisher
    ..However, in the more favorable patients with scores of 17-18, longer-course WBRT with lower doses per fraction should be considered, as these schedules have been associated with less neurocognitive toxicity. ..
  7. Darakchiev B, Albright R, Breneman J, Warnick R. Safety and efficacy of permanent iodine-125 seed implants and carmustine wafers in patients with recurrent glioblastoma multiforme. J Neurosurg. 2008;108:236-42 pubmed publisher
    ..This novel approach warrants further investigation in recurrent and newly diagnosed GBM. ..
  8. Chow E, Fan G, Hadi S, Wong J, Kirou Mauro A, Filipczak L. Symptom clusters in cancer patients with brain metastases. Clin Oncol (R Coll Radiol). 2008;20:76-82 pubmed
    ..However, different symptoms clustered at various time points. The effectiveness of whole brain radiotherapy in providing palliative relief to patients with brain metastases needs to be explored with regards to symptom clusters. ..
  9. Chamberlain M, Johnston S, Glantz M. Neoplastic meningitis-related prognostic significance of the Karnofsky performance status. Arch Neurol. 2009;66:74-8 pubmed publisher
    The prognostic significance of Karnofsky performance status in neoplastic meningitis (NM) has not been demonstrated in patient groups similarly matched for known prognostic variables...
  10. Sperduto P, Berkey B, Gaspar L, Mehta M, Curran W. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70:510-4 pubmed
    ..The GPA is the least subjective, most quantitative and easiest to use of the four indices. Future clinical trials should compare the GPA with the RPA to prospectively validate these findings. ..
  11. Sculier J, Lafitte J, Paesmans M, Lecomte J, Alexopoulos C, Van Cutsem O, et al. Chemotherapy improves low performance status lung cancer patients. Eur Respir J. 2007;30:1186-92 pubmed
    ..2 versus 2.1%). In conclusion, combination chemotherapy is associated with clinical improvement in a substantial number of patients with advanced nonsmall cell lung cancer of poor performance status. ..
  12. Dajczman E, Kasymjanova G, Kreisman H, Swinton N, Pepe C, Small D. Should patient-rated performance status affect treatment decisions in advanced lung cancer?. J Thorac Oncol. 2008;3:1133-6 pubmed publisher
    ..Almost half the patients would have excluded themselves from a hypothetical clinical trial (Pt-PS >/=2). This requires prospective evaluation. ..
  13. Clarke J, Perez H, Jacks L, Panageas K, DeAngelis L. Leptomeningeal metastases in the MRI era. Neurology. 2010;74:1449-54 pubmed publisher
    ..Of these, 150 had solid and 37 had hematopoietic malignancies. Median age was 56.4 years, and median Karnofsky performance status (KPS) was 70...
  14. Xu T, Zhao H, Yan Y, Wang S, Zhu X. [Survival analysis on advanced non-small cell lung cancer with a Buckley-James model]. Zhonghua Liu Xing Bing Xue Za Zhi. 2010;31:1179-83 pubmed
    ..575>0.05). KPS, clinical stage, treatment and pre-treatment hemoglobin might be associated. Both the prognosis of patients with advanced NSCLC and the prediction model seemed to have practical significances. ..
  15. Shu Z, Hou Y, Wang Y, Tang X. [Comparison of prognosis of skull base chordoma treated by surgical resection and gamma knife surgery]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011;36:359-62 pubmed publisher
    ..138). Despite the poor prognosis of skull base chordoma, GKS can effectively improve the survival rate and present life quality of patients with skull base chordoma. ..
  16. Banfill K, Bownes P, St Clair S, Loughrey C, Hatfield P. Stereotactic radiosurgery for the treatment of brain metastases: impact of cerebral disease burden on survival. Br J Neurosurg. 2012;26:674-8 pubmed publisher
    ..Data on survival, primary tumour, Karnofsky performance status, time from diagnosis to identification of brain metastases, previous treatment for brain metastases and ..
  17. Wiggenraad R, Verbeek de Kanter A, Mast M, Molenaar R, Kal H, Lycklama A Nijeholt G, et al. Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases. A single centre study. Strahlenther Onkol. 2012;188:696-701 pubmed publisher
    ..For better local control rates, FSRT schemes with a higher biological equivalent dose may be necessary. ..
  18. Kalmanti L, Saussele S, Lauseker M, Proetel U, Muller M, Hanfstein B, et al. Younger patients with chronic myeloid leukemia do well in spite of poor prognostic indicators: results from the randomized CML study IV. Ann Hematol. 2014;93:71-80 pubmed publisher
    ..We conclude that AYAs show more aggressive features and poor prognostic indicators possibly indicating differences in disease biology. This, however, does not affect outcome. ..
  19. Hong B, Hermann E, Reuter C, Brandis A, Krauss J. Outcome of surgical decompression of spinal mass lesions in non-Hodgkin's lymphoma and plasmacytoma. Clin Neurol Neurosurg. 2013;115:2476-81 pubmed publisher
    ..Long-term outcome after postoperative adjuvant therapy confirms prolonged stability of quality of life. ..
  20. Ironside S, Das S, Sahgal A, Moroney C, Mainprize T, Perry J. Optimal Therapies for Newly Diagnosed Elderly Patients with Glioblastoma. Curr Treat Options Oncol. 2017;18:66 pubmed publisher
    ..of adjuvant radiation and chemotherapy is appropriate in selected elderly patients with favourable Karnofsky performance status (KPS) who cannot tolerate a longer 6-week course of fractionated radiotherapy...
  21. Polley M, Lamborn K, Chang S, Butowski N, Clarke J, Prados M. Conditional probability of survival in patients with newly diagnosed glioblastoma. J Clin Oncol. 2011;29:4175-80 pubmed publisher
    ..Our data also showed that the constant hazard assumption may be violated in modern brain tumor trials. For single-arm trials, we advise using individual patient data from historical data sets for efficacy comparisons. ..
  22. Baggott C, Cooper B, Marina N, Matthay K, Miaskowski C. Symptom cluster analyses based on symptom occurrence and severity ratings among pediatric oncology patients during myelosuppressive chemotherapy. Cancer Nurs. 2012;35:19-28 pubmed publisher
    ..The dissemination of symptom cluster research methodology through publication and presentation may promote uniformity in this field. ..
  23. Honig S, Trantakis C, Frerich B, Sterker I, Kortmann R, Meixensberger J. Meningiomas involving the sphenoid wing outcome after microsurgical treatment--a clinical review of 73 cases. Cent Eur Neurosurg. 2010;71:189-98 pubmed publisher
    ..The result of this study affirms the safety of microsurgical treatment strategies, so that sufficient tumor control can be achieved with minimal morbidity and satisfying functional results in most cases. ..
  24. Milligan B, Meyer F. Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience. Neurosurgery. 2010;67:1483-96; discussion 1496 pubmed publisher
    ..Resection of an intraventricular mass can result in life-altering complications. Many advocate transcallosal rather than transcortical approaches to these lesions, citing differential postoperative seizure risk...
  25. Bostrom A, Bostrom J, Hartmann W, Pietsch T, Feuss M, von Lehe M, et al. Treatment results in patients with intracranial ependymomas. Cent Eur Neurosurg. 2011;72:127-32 pubmed publisher
    ..Surgery alone, as the primary treatment, achieves a good outcome in most patients with E II. Good results can be achieved with surgery and adjuvant local radiotherapy in patients with AE III. ..
  26. Saylor D, Nakigozi G, Nakasujja N, Robertson K, Gray R, Wawer M, et al. Peripheral neuropathy in HIV-infected and uninfected patients in Rakai, Uganda. Neurology. 2017;89:485-491 pubmed publisher
    ..of neuropathy symptoms, functional measures (Patient Assessment of Own Functioning Inventory and Karnofsky Performance Status scores), and neurologic evaluation by a trained medical officer...
  27. De Vleeschouwer S, Ardon H, Van Calenbergh F, Sciot R, Wilms G, van Loon J, et al. Stratification according to HGG-IMMUNO RPA model predicts outcome in a large group of patients with relapsed malignant glioma treated by adjuvant postoperative dendritic cell vaccination. Cancer Immunol Immunother. 2012;61:2105-12 pubmed publisher
    ..The model appears useful for prognostic patient counseling for patients participating in DC vaccination trials. A substantial number of long-term survivors after relapse are seen in class I to III, but not in class IV patients. ..
  28. Biswas A, Kumar N, Kumar P, Vasishta R, Gupta K, Sharma S, et al. Primary gliosarcoma--clinical experience from a regional cancer centre in north India. Br J Neurosurg. 2011;25:723-9 pubmed publisher
    ..6%). Median survival of only 8.27 months in our series is in concert with the existing survival result of primary gliosarcoma in world literature (6.25-11.5 months). ..
  29. Stummer W, Nestler U, Stockhammer F, Krex D, Kern B, Mehdorn H, et al. Favorable outcome in the elderly cohort treated by concomitant temozolomide radiochemotherapy in a multicentric phase II safety study of 5-ALA. J Neurooncol. 2011;103:361-70 pubmed publisher
    ..Thus, older patients should not generally be excluded from accepted therapies (fluorescence-guided resection plus RT/TMZ). ..
  30. Chargari C, Idrissi H, Pierga J, Bollet M, Dieras V, Campana F, et al. Preliminary results of whole brain radiotherapy with concurrent trastuzumab for treatment of brain metastases in breast cancer patients. Int J Radiat Oncol Biol Phys. 2011;81:631-6 pubmed publisher
    ..Although promising, these preliminary data warrant additional validation of trastuzumab as a potential radiosensitizer for WBRT in brain metastases from breast cancer in the setting of a clinical trial. ..
  31. Fairchild A, Debenham B, Danielson B, Huang F, Ghosh S. Comparative multidisciplinary prediction of survival in patients with advanced cancer. Support Care Cancer. 2014;22:611-7 pubmed publisher
    ..04). Factors most frequently cited as influencing correct predictions were Karnofsky performance status (KPS), extent of disease, and histology...
  32. Hjermstad M, Lie H, Caraceni A, Currow D, Fainsinger R, Gundersen O, et al. Computer-based symptom assessment is feasible in patients with advanced cancer: results from an international multicenter study, the EPCRC-CSA. J Pain Symptom Manage. 2012;44:639-54 pubmed publisher
    ..9% (n = 965), with median age 63 years (range 18-91 years) and median Karnofsky Performance Status (KPS) score of 70 (range 20-100)...
  33. Lopez W, Trippel M, Doostkam S, Reithmeier T. Interstitial brachytherapy with iodine-125 seeds for low grade brain stem gliomas in adults: diagnostic and therapeutic intervention in a one-step procedure. Clin Neurol Neurosurg. 2013;115:1451-6 pubmed publisher
    ..Furthermore randomized studies are needed to confirm the therapeutic impact of this method in comparison to external beam radiation of brain stem gliomas. ..
  34. Qiu C, Yang N, Tian G, Liu H. Weight loss during radiotherapy for nasopharyngeal carcinoma: a prospective study from northern China. Nutr Cancer. 2011;63:873-9 pubmed publisher
    ..weight loss: global quality of life, body mass index, N stage, insomnia, radiation techniques, Karnofsky performance status, concurrent chemotherapy, and fatigue...
  35. Sehmisch L, Schild S, Rades D. Development of a Survival Score for Patients with Cerebral Metastases from Melanoma. Anticancer Res. 2017;37:249-252 pubmed
    ..0001). A survival score was developed for patients assigned to WBI alone for cerebral metastases from melanoma. This new instrument may facilitate the decision for the appropriate WBI-program. ..
  36. Kiely B, Martin A, Tattersall M, Nowak A, Goldstein D, Wilcken N, et al. The median informs the message: accuracy of individualized scenarios for survival time based on oncologists' estimates. J Clin Oncol. 2013;31:3565-71 pubmed publisher
    ..004), dry mouth (HR = 5.1; P < .0001), alkaline phosphatase more than 101 U/L (HR = 2.8; P = .0002), Karnofsky performance status ? 70 (HR = 2.3; P = .007), prostate primary (HR = 0.23; P = .002), and steroid use (HR = 2.4; P = .02)...
  37. Sreeraman R, Vijayakumar S, Chen A. Correlation of radiation treatment interruptions with psychiatric disease and performance status in head and neck cancer patients. Support Care Cancer. 2013;21:3301-6 pubmed publisher
    ..The percentage of patients who missed greater than 5 days was 62 % among the 39 patients with Karnofsky Performance Status (KPS) score of 70 or less compared to 10 % among those with a KPS score of greater than 70 (p?<?0...
  38. Chen C, Wang F, Wang Z, Li C, Luo H, Liang Y, et al. Polymorphisms in ERCC1 C8092A predict progression-free survival in metastatic/recurrent nasopharyngeal carcinoma treated with cisplatin-based chemotherapy. Cancer Chemother Pharmacol. 2013;72:315-22 pubmed publisher
    ..The ERCC1 C8092A polymorphism might be a useful predictive marker in metastatic/recurrent NPC patients treated with cisplatin-based chemotherapy. However, a large-scale prospective study is warranted to validate our findings. ..
  39. Goebel S, Mehdorn H. Measurement of psychological distress in patients with intracranial tumours: the NCCN distress thermometer. J Neurooncol. 2011;104:357-64 pubmed publisher
    ..The DT is a valid and practicable screening instrument for assessment of levels and sources of distress in patients with intracranial tumours in the neurosurgical setting. ..
  40. Meattini I, Livi L, Saieva C, Franceschini D, Marrazzo L, Greto D, et al. Prognostic factors and clinical features in patients with leptominengeal metastases from breast cancer: a single center experience. J Chemother. 2012;24:279-84 pubmed publisher
    ..0047; HR: 3.34; CI 95% 1.45-7.73). Our experience confirms that performance status is probably the most important prognostic factor in these patients. Multimodality approach is probably the best option. ..
  41. Kandaz M, Ertekin M, Bilici M. Retrospective analysis of patients with esophageal cancer treated with radiotherapy and/or chemoradiotherapy. Tumori. 2012;98:445-50 pubmed publisher
  42. Liu D, Yuan X, Liu Q, Jiang X, Jiang W, Peng Z, et al. Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases. Turk Neurosurg. 2012;22:547-57 pubmed publisher
    ..The size of tumor affected the extent of tumor removal determining clinical outcomes including VA improvement and KPS score immediately after surgery; however, it was not correlated with long-term overall outcomes. ..
  43. Miro J, Manzardo C, Zamora L, Pumarola T, Herreras Z, Gallart T, et al. [Clinical management of acute and chronic human immunodeficiency virus infection before starting antiretroviral treatment]. Enferm Infecc Microbiol Clin. 2011;29:759-72 pubmed publisher
    ..No less important is the psychological support, as these patients must learn to live with a chronic infection, which managed properly can ensure a very good long-term prognosis and quality of life. ..
  44. Wang L, Qin H, Li L, Feng F, Ji P, Zhang J, et al. Forkhead-box A1 transcription factor is a novel adverse prognosis marker in human glioma. J Clin Neurosci. 2013;20:654-8 pubmed publisher
  45. Bertheussen G, Oldervoll L, Kaasa S, Sandmæl J, Helbostad J. Measurement of physical activity in cancer survivors--a comparison of the HUNT 1 Physical Activity Questionnaire (HUNT 1 PA-Q) with the International Physical Activity Questionnaire (IPAQ) and aerobic capacity. Support Care Cancer. 2013;21:449-58 pubmed publisher
    ..Aerobic capacity measures other aspect of PA and should be used as a supplement to PA questionnaire when the aim is to capture health effects related to aerobic capacity. ..
  46. Salloum R, Smith T, Jensen G, Lafata J. Using claims-based measures to predict performance status score in patients with lung cancer. Cancer. 2011;117:1038-48 pubmed publisher
    ..55) when the cutoff was 0.70. The goodness-of-fit c statistic was 0.76 or 0.78. PS can be estimated, with some accuracy, using claims-based measures. Emphasis should be placed on documenting PS in medical records and tumor registries. ..
  47. Saini A, Tucci M, Tampellini M, Maina D, Bouraouia K, Giuliano P, et al. Circadian variation of breakthrough pain in cancer patients. Eur J Pain. 2013;17:264-70 pubmed publisher
    ..BTP episodes negatively correlated with quality of life. BTP onset follows a circadian rhythm, with an acrophase occurring in the late morning. ..
  48. Wang X, Liu J, Lin H, Hou W. A multicenter randomized controlled open-label trial to assess the efficacy of compound kushen injection in combination with single-agent chemotherapy in treatment of elderly patients with advanced non-small cell lung cancer: study protocol for a ran. Trials. 2016;17:124 pubmed publisher
    ..two cycles, the disease control rate, objective response rate, clinical symptoms, quality of life, Karnofsky Performance Status, and side effects will be assessed...
  49. Sonpavde G, Vogelzang N, Galsky M, Raghavan V, Daniel S. Objective measures of physical functional capacity warrant exploration to complement or replace the subjective physician estimated performance status. Am J Clin Oncol. 2012;35:163-6 pubmed publisher
    ..We explore and discuss attractive candidates for objective measures of physical functioning. ..
  50. Lakomy R, Fadrus P, Slampa P, Svoboda T, Kren L, Lzicarova E, et al. [Multimodal treatment of glioblastoma multiforme: results of 86 consecutive patients diagnosed in period 2003-2009]. Klin Onkol. 2011;24:112-20 pubmed
    ..Our experience indicates that performance status should be the main factor in decisions about treatment intensity. Treatment of malignant glioma requires a multidisciplinary team. ..
  51. Tang X, Yin X, Zhang T, Peng H. The effect of hyperbaric oxygen on clinical outcome of patients after resection of meningiomas with conspicuous peritumoral brain edema. Undersea Hyperb Med. 2011;38:109-15 pubmed
    ..05). HBO2 therapy is effective in reducing edema formation and neurological deficits after resection of meningiomas with conspicuous PTBE. ..
  52. Kaťuchová J, Bober J, Harbuľák P, Radonak J. Perioperative and follow-up results in chronic pancreatitis patients after pancreatic resection. Wien Klin Wochenschr. 2011;123:359-63 pubmed publisher
    ..0001). The presence of postoperative complications had no significant influence on long-term quality of life. Surgery for patients with chronic pancreatitis can be performed safely with minimal morbidity and very good long-term results. ..
  53. Lester Coll N, Dosoretz A, Yu J. Decision analysis of stereotactic radiation surgery versus stereotactic radiation surgery and whole-brain radiation therapy for 1 to 3 brain metastases. Int J Radiat Oncol Biol Phys. 2014;89:563-8 pubmed publisher
    ..analysis model was used to compare QALE in a cohort of patients with 1 to 3 brain metastases and Karnofsky performance status of at least 70. Patients were treated with SRS alone or with SRS immediately followed by WBRT...