Advertisement

Prognostic Indices for Patients with Brain Metastases

  • Paul W. SperdutoEmail author
Chapter

Abstract

Patients with brain metastases are a heterogenous population. The epidemiology of brain metastases is addressed elsewhere in this textbook. In the past, outcomes were considered uniformly grim for all patients with brain metastases. We now know that outcomes vary widely by diagnosis (type of primary cancer) and diagnosis-specific prognostic factors. This chapter reviews the history of prognostic classifications for patients with brain metastases and the current state of knowledge in this area. Such classification systems are important for two reasons: (1) they facilitate clinical decision-making regarding whether and what treatment is appropriate and (2) they provide a method for stratification of clinical trials to ensure trials are comparing comparable patients, which is particularly important in such a heterogeneous patient population.

Keywords

Brain metastases Outcomes Prognosis 

Notes

Acknowledgements

This work has been a collaborative multi-institutional effort. The faculty and residents of the following institutions have selflessly contributed time and energy to one or more of the studies on the Graded Prognostic Assessment: MD Anderson, Memorial Sloan Kettering Cancer Center, Mayo Clinic, University of California San Francisco, Mayo Clinic, Massachusetts General Hospital, Dana Farber Cancer Institute, Duke University, Yale University, University of Colorado Denver, Cleveland Clinic, University of Wisconsin Madison, McGill University and Centre Hospitalier de l’ Université de Montreal, University of Maryland, University of Alabama Birmingham and the University of Minnesota. This work would not have been possible without the tireless work of these dedicated colleagues. Special recognition is appropriate for Ryan Shanley who has provided his statistical wisdom for nearly a decade.

References

  1. 1.
    Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neuro-Oncol. 2005;75(1):5–14.CrossRefGoogle Scholar
  2. 2.
    Park DM, Posner JB. Management of intracranial metastases: history. In: Sawaya R, editor. Intracranial metastases: current management strategies. Oxford: Blackwell Publishing Ltd; 2004. p. 3–19.Google Scholar
  3. 3.
    Yamamoto M, Serizawa T, Shuto T, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014;15(4):387–95.CrossRefGoogle Scholar
  4. 4.
    Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases, a randomized controlled trial. JAMA. 2006;295:2483–91.CrossRefGoogle Scholar
  5. 5.
    Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomized controlled trial. Lancet Oncol. 2009;10:1037–44.CrossRefGoogle Scholar
  6. 6.
    Kocher M, Soffietti R, Abacioglu U, et al. Adjuavant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: resuts of the EORTC 22952-26001 study. J Clin Oncol. 2011;29:134–41.CrossRefGoogle Scholar
  7. 7.
    Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases. JAMA. 4:401–9.Google Scholar
  8. 8.
    Mulvenna P, Nankivell M, Barton R, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomized trial. Lancet. 2016;388:2004–14.CrossRefGoogle Scholar
  9. 9.
    Gaspar LE, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37:745–51.CrossRefGoogle Scholar
  10. 10.
    Weltman E, Salvajoli JV, Brandt RA, et al. Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys. 2000;46:1155–61.CrossRefGoogle Scholar
  11. 11.
    Lorenzoni J, Devriendt D, Massager N, et al. Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems. Int J Radiat Oncol Biol Phys. 2004;60:218–24.CrossRefGoogle Scholar
  12. 12.
    Sloan-Barnholtz-Sloan JS, Yu C, Sloan AE, et al. A nomogramfor individualized estimation of survival among patients with brain metastasis. Neuro-Oncology. 2012;14:910–8.CrossRefGoogle Scholar
  13. 13.
    Kondziolka D, Parry PV, Lunsford DL, et al. The accuracy of predicting survival in individual patients with cancer. J Neurosurg. 2014;120:24–30.CrossRefGoogle Scholar
  14. 14.
    Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70:510–4.CrossRefGoogle Scholar
  15. 15.
    Sperduto PW, Chao ST, Sneed PK, 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.CrossRefGoogle Scholar
  16. 16.
    Sperduto PW, Kased N, Roberge D, et al. The effect of tumor subtype on survival and the graded prognostic assessment (GPA) for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys. 2011;  https://doi.org/10.1016/j.ijrobp.2011.02.027.CrossRefGoogle Scholar
  17. 17.
    Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Onc. 2011;30:419–25.CrossRefGoogle Scholar
  18. 18.
    Sperduto PW, Yang TJ, Beal K, et al. The effect of gene alterations and tyrosine kinase inhibition on survival and cause of death in patients with adenocarcinoma of the lung and brain metastases. Int J Radiat Oncol Biol Phys. 2016;96(2):406–13.CrossRefGoogle Scholar
  19. 19.
    Sperduto PW, Yang TJ, Beal K, et al. Improved survival and prognostic ability in lung cancer patients with brain metastases: an update of the graded prognostic assessment for lung cancer using molecular markers (lung-molGPA). JAMA Oncol. 2017;3(6):827–31.CrossRefGoogle Scholar
  20. 20.
    Sperduto PW, Jiang W, Brown PD, et al. The prognostic value of BRAF, cKIT and NRAS mutations in melanoma patients with brain metastases. Int J Radiat Oncol Biol Phys. 2017;98(5):1069–77.CrossRefGoogle Scholar
  21. 21.
    Sperduto PW, Jiang W, Brown PD, et al. Estimating survival in melanoma patients with brain metastases: an update of the graded prognostic assessment for melanoma using molecular markers (melanoma-molGPA). Int J Radiat Oncol Biol Phys. 2017;99(4):812–6.CrossRefGoogle Scholar
  22. 22.
    Sperduto PW, Deegan BJ, Li J, et al. The effect of targeted therapies on prognostic factors, patterns of care and survival in patients with renal cell carcinoma and brain metastases. Int J Radiat Oncol Biol Phys. 2018;101(4):845–53.CrossRefGoogle Scholar
  23. 23.
    Sperduto PW, Deegan BJ, Li J, et al. Estimating survival for renal cell carcinoma patients with brain metastases: an update of the renal graded prognostic assessment (renal-GPA). Neuro-Oncology. 2018 Nov 12;20(12):1652–60.  https://doi.org/10.1093/neuonc/noy099.CrossRefPubMedGoogle Scholar
  24. 24.
    Sperduto WA, King D, Watanabe Y, Lou E, Sperduto PS. Cureus. 9(12):e1947.  https://doi.org/10.7759/cureus.1947.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Minneapolis Radiation Oncology and Gamma Knife CenterThe University of Minnesota Medical CenterMinneapolisUSA

Personalised recommendations