Diagnosis-Specific Prognostic Factors, Indexes, and Treatment Outcomes for Patients With Newly Diagnosed Brain Metastases: A Multi-Institutional Analysis of 4,259 Patients

Sperduto, Paul W.; Chao, Samuel T.; Sneed, Penny K.; Luo, Xianghua; Suh, John; Roberge, David; Bhatt, Amit; Jensen, Ashley W.; Brown, Paul D.; Shih, Helen; Kirkpatrick, John; Schwer, Amanda; Gaspar, Laurie E.; Fiveash, John B.; Chiang, Veronica; Knisely, Jonathan; Sperduto, Christina Maria; Mehta, Minesh

doi:10.1016/j.ijrobp.2009.08.025

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 77, Issue 3 , Pages 655-661, 1 July 2010

Diagnosis-Specific Prognostic Factors, Indexes, and Treatment Outcomes for Patients With Newly Diagnosed Brain Metastases: A Multi-Institutional Analysis of 4,259 Patients

Paul W. Sperduto, M.D., M.P.P.
- Gamma Knife Center, University of Minnesota, Minneapolis, MN
- Reprint requests to: Paul Sperduto, M.D., M.P.P., Gamma Knife Center, University of Minnesota, 560 S. Maple St., Waconia, MN 55387. Tel: (952) 442-6000; Fax: (952) 442-7851
Samuel T. Chao, M.D.
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH
Penny K. Sneed, M.D.
- Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA
Xianghua Luo, Ph.D.
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
John Suh, M.D.
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH
David Roberge, M.D.
- Department of Radiation Oncology, McGill University Health Center, Montreal, ON, Canada
Amit Bhatt, M.D.
- Department of Human Oncology, University of Wisconsin at Madison, Madison, WI
Ashley W. Jensen, M.D.
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
Paul D. Brown, M.D.
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
Helen Shih, M.D.
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
John Kirkpatrick, M.D., Ph.D.
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
Amanda Schwer, M.D.
- Department of Radiation Oncology, University of Colorado Health Science Center, Denver, CO
Laurie E. Gaspar, M.D.
- Department of Radiation Oncology, University of Colorado Health Science Center, Denver, CO
John B. Fiveash, M.D.
- Department of Radiation Oncology, University of Alabama Medical Center at Birmingham, Birmingham, AL
Veronica Chiang, M.D.
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
Jonathan Knisely, M.D.
- Department of Radiation Oncolog, Yale University School of Medicine, New Haven, CT
Christina Maria Sperduto
- Minneapolis Radiation Oncology, Minneapolis, MN
Minesh Mehta, M.D.
- Department of Human Oncology, University of Wisconsin at Madison, Madison, WI

Received 16 June 2009; received in revised form 7 August 2009; accepted 10 August 2009. published online 25 November 2009.

Purpose

Controversy endures regarding the optimal treatment of patients with brain metastases (BMs). Debate persists, despite many randomized trials, perhaps because BM patients are a heterogeneous population. The purpose of the present study was to identify significant diagnosis-specific prognostic factors and indexes (Diagnosis-Specific Graded Prognostic Assessment [DS-GPA]).

Methods and Materials

A retrospective database of 5,067 patients treated for BMs between 1985 and 2007 was generated from 11 institutions. After exclusion of the patients with recurrent BMs or incomplete data, 4,259 patients with newly diagnosed BMs remained eligible for analysis. Univariate and multivariate analyses of the prognostic factors and outcomes by primary site and treatment were performed. The significant prognostic factors were determined and used to define the DS-GPA prognostic indexes. The DS-GPA scores were calculated and correlated with the outcomes, stratified by diagnosis and treatment.

Results

The significant prognostic factors varied by diagnosis. 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 diagnoses. For melanoma and renal cell cancer, the significant prognostic factors were Karnofsky performance status and the number of BMs. For breast and gastrointestinal cancer, the only significant prognostic factor was the Karnofsky performance status. Two new DS-GPA indexes were thus designed for breast/gastrointestinal cancer and melanoma/renal cell carcinoma. The median survival by GPA score, diagnosis, and treatment were determined.

Conclusion

The prognostic factors for BM patients varied by diagnosis. The original GPA was confirmed for non–small-cell lung cancer and small-cell lung cancer. New DS-GPA indexes were determined for other histologic types and correlated with the outcome, and statistical separation between the groups was confirmed. These data should be considered in the design of future randomized trials and in clinical decision-making.

Brain metastases, prognosis, radiotherapy, stereotactic radiosurgery