DP chemotherapy combined with concurrent TRT is an alternative to MVP chemotherapy for patients with LA-NSCLC.

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Object The purpose of this study was to validate a new prognostic index for patients with brain metastases. This index, the Graded Prognostic Assessment (GPA), is based on an analysis of 1960 patients whose data were extracted from the Radiation Therapy Oncology Group (RTOG) database. The GPA is based on 4 criteria: age, Karnofsky Performance Scale score, number of brain metastases, and the presence/absence of extracranial metastases. Each of the 4 criteria is given a score of 0, 0.5, or 1.0, so the patient with best prognosis would have a GPA score of 4.0. Methods Between April 2005 and December 2006, 140 eligible patients with brain metastases were treated at the Gamma Knife Center at the University of Minnesota. The GPA score was calculated for each patient, and the score was then correlated with survival. Survival duration was calculated from the date treatment began for the brain metastases. Eligibility criteria included patients treated with whole-brain radiation therapy, stereotactic radiosurgery, or both. Results The median survival time in months observed in the RTOG and Minnesota data by GPA score was as follows: GPA 3.5–4.0, 11.0 and 21.7; GPA 3.0, 8.9 and 17.5; GPA 1.5–2.5, 3.8 and 5.9; and GPA 0–1.0, 2.6 and 3.0, respectively. Conclusions The University of Minnesota data correlate well with the RTOG data and validate the use of the GPA as an effective prognostic index for patients with brain metastases. Clearly, not all patients with brain metastases have the same prognosis, and treatment decisions should be individualized accordingly. The GPA score does appear to be as prognostic as the RPA and is less subjective (because the RPA requires assessment of whether the primary disease is controlled), more quantitative, and easier to use and remember. A multiinstitutional validation study of the GPA is ongoing.

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One can estimate photon attenuation properties from the CT number. In a standard method one assumes that the linear attenuation coefficient is proportional to electron density and ignores its nonlinear dependence on atomic number. When the photon energy is lower than about 50 keV, such as for brachytherapy applications, however, photoelectric absorption and Rayleigh scattering become important. Hence the atomic number must be explicitly considered in estimating the linear attenuation coefficient. In this study we propose a method to more accurately estimate the linear attenuation coefficient of low-energy photons from CT numbers. We formulate an equation that relates the CT number to the electron density and the effective atomic number. We use a CT calibration phantom to determine unknown coefficients in the equation. The equation with a given CT number is then solved for the effective atomic number, which in turn is used to calculate the linear attenuation coefficient for low-energy photons. We use the CT phantom to test the new method. The method significantly improves the standard method in estimating the attenuation coefficient at low photon energies (20 keV< or = E < or = 40 keV) for materials with high atomic numbers.