An instrument was designed to predict the 6-month survival of patients receiving WBI for cerebral metastases from gynecological cancer and facilitate personalized care.

Background/Aim: Existing survival scores for patients with brain metastases were created in heterogeneously treated cohorts. A new score was developed in 56 patients with brain metastases from colorectal cancer treated with 10×3 Gy of whole-brain radiotherapy (WBRT). Patients and Methods: Factors found significantly associated with survival (p<0.05) or showing a trend (p<0.08) were included in the tool. The new WBRT-30-CRC was compared to diagnosis-specific graded prognostic assessment (DS-GPA) classification for gastrointestinal cancers. Results: The WBRT-30-CRC included four prognostic groups: 3-4, 5-6, 7-9 and 10 points. Six-month survival rates were 0%, 15%, 38% and 80%. PPV of the 3-4 points-group predicting death ≤6 months was 100% (91% for DS-GPA of 0.0-1.0). PPV of the 10 points-group predicting survival ≥6 months was 80% (0% DS-GPA of 3.5-4.0, 33% DS-GPA of 3.0-4.0). Conclusion: The WBRT-30-CRC appeared very precise in identifying patients with brain metastases from colorectal cancer dying ≤6 months or surviving ≥6 months. Brain metastases are relatively common and occur in 20-40% of adult cancer patients during their malignant disease (1). Despite the fact that radiosurgery and fractionated stereotactic radiotherapy have become more popular during recent years, many patients with brain metastases receive whole-brain radiotherapy (WBRT) alone, particularly those with more than three lesions, significant comorbidities, or poor 2569 This article is freely accessible online.

Diagnosis-specific survival scores including a new score developed in 157 patients with brain metastases from small-cell lung cancer (SCLC) receiving whole-brain radiotherapy (WBRT) with 30 Gy in 10 fractions (WBRT-30-SCLC) were compared. Three prognostic groups were designed based on the 6-month survival probabilities of significant or almost significant factors, (age, performance score, number of brain metastases, extra-cerebral metastasis). Six-month survival rates were 6% (6–11 points), 44% (12–14 points) and 86% (16–19 points). The WBRT-30-SCLC was compared to three disease-specific scores for brain metastasis from SCLC, the original and updated diagnosis-specific graded prognostic assessment DS-GPA classifications and the Rades-SCLC. Positive predictive values (PPVs) used to correctly predict death ≤6 months were 94% (WBRT-30-SCLC), 88% (original DS-GPA), 88% (updated DS-GPA) and 100% (Rades-SCLC). PPVs to predict survival ≥6 months were 86%, 75%, 76% and 100%. For WBRT-30-SCLC and Rades-SCLC, differences between poor and intermediate prognoses groups and between intermediate and favorable prognoses groups were significant. For both DS-GPA classifications, only the difference between poor and intermediate prognoses groups was significant. Of these disease-specific tools, Rades-SCLC appeared to be the most accurate in identifying patients dying ≤6 months and patients surviving ≥6 months after irradiation, followed by the new WBRT-30-SCLC and the DS-GPA classifications.

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Background/Aim: Many patients with brain metastases receive whole-brain radiotherapy (WBRT). An important question is whether a delay between diagnosis of brain metastases and treatment impairs the patient's prognosis. Patients and Methods: This retrospective study investigated the impact of the interval between diagnosis of brain metastases and WBRT plus ten additional factors on overall survival (OS) in 573 patients. Prospective trials cannot be performed due to ethical concerns. Results: On univariate analyses, age (p<0.001), performance status (p<0.001), controlled primary tumor (p=0.047), metastases outside the brain (p<0.001) and completion of WBRT (p<0.001) were associated with OS. The interval between diagnosis and WBRT had no significant impact (p=0.84). On multivariate analysis, age (p=0.047), performance status (p<0.001), metastases outside the brain (p=0.029) and completion of WBRT (p<0.001) maintained significance. Conclusion: WBRT may be postponed for good reasons (multidisciplinary coordination of treatment, missing histology). OS was significantly associated with previously identified factors, which demonstrates consistency of the present data.Depending on the type of primary tumor, up to 30% of adult cancer patients develop brain metastases during the course of their malignant disease (1). The majority of these patients have already more than three metastases at their first presentation. This situation is often associated with a poor overall survival (OS). Therefore, whole-brain radiotherapy (WBRT) alone is the most common treatment for this patient group. For patients with a very limited number of brain metastases, WBRT may be combined with a local treatment such as neurosurgical resection or stereotactic radiosurgery (SRS)/fractionated stereotactic radiotherapy (FSRT) (2). In patients with very few intracerebral lesions and a low risk of developing new brain metastases outside the treated lesions, SRS may be delivered without WBRT (3). However, many patients with poor performance status or significant co-morbidities and a few brain metastases receive WBRT alone because they would not tolerate neurosurgery or SRS (4). Generally, it is considered important that WBRT is started as soon as possible, because brain metastases often cause significant symptoms such as headache, nausea/vomiting and neurologic deficits (5, 6). Several issues may cause a delay of up to two or three weeks between the diagnosis of brain metastases and the start of WBRT, e.g. presentation and discussion of the case in a multidisciplinary tumor board, waiting for a definitive histology, treatment planning, and sometimes even limited capacities of linear accelerators. An important question is whether such a delay has a negative impact on the patient's prognosis. This question has not yet been evaluated. Therefore, we investigated the potential impact of the interval between diagnosis of brain metastasis and start of WBRT on OS. In order to reduce the risk of a selection bias due to the WBRT regimen, only patients assigned to l...