A New Scoring System to Predicting the Survival of Patients Treated with Whole-Brain Radiotherapy for Brain Metastases

Abstract

Patients with brain metastases receiving WBRT can be grouped with this score to estimate survival. Short-course and longer-course WBRT resulted in similar survival in all groups studied. 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.

The effectiveness of brain metastases radiotherapy in patients with melanoma

“…In this case also the site's experience was compared with the results published by other authors [1,5,13,14,37,40,46]. Some investigators point to the adverse prognostics significance of the presence of metastases outside the brain, in particular in the lungs, liver, spleen and adrenal glands, and, to a lesser degree, in the bones, lymph nodes and skin [5,6,8,30,31,[33][34][35][40][41][42]. In the site's own material, in a single-variance analysis, it was shown that the co-existence of the metastases in extracranial locations was an adverse prognostic factor, which was, however, not confirmed by the results of the multivariance analysis.…”

“…Rades et al in turn, distinguishes two groups of patients: with 1-3 MBM foci and with more than 3 MBM foci; and Weltman and Sperduto propose breaking down the patient groups into 3 categories: with 1, with 2-3 and more than 3 MBM [32,34,36]. Table VII presents the mean survival periods of patients with MBM depending on the number of metastatic foci in the brain, and thus in the case of isolated metastases the survival periods were 5.9-8 months and were twice as short in the case of multiple MBMs.…”

“…There have been many publications with prognostic indexes for patients with brain metastases of various types of cancers: RPA-RTOG (Recursive Partitioning Analysis -Radiation Therapy Oncology Group), Rotterdam, SIR (Score Index for Radiosurgery), BSBM (Basic Score for Brain Metastases), Rades et al score, GPA (Graded Prognostic Assessment), MM-GKR (Malignant Melanoma -Gamma Knife Radiosurgery), MS-GPA (melanoma-specific GPA) [30][31][32][33][34][35][36].…”

Classification of Brain Metastases Prognostic Groups Utilizing Artificial Neural Network Approaches

“…Additionally, such indices can support the conduct of prospective clinical trials by defining patient eligibility and stratification criteria. Multiple prognostic factors have been shown to be related to patient survival in the context of brain metastases which include: performance status, extracranial disease, age, controlled primary, primary site, interval between primary disease and brain metastases, number/volume of brain metastases, and clinical response to steroids [1][2][3][4][5][6][7][8][9][10][11]. The Radiation Therapy Oncology Group (RTOG) Recursive Partitioning Analysis (RPA) brain metastases prognostic index is the oldest system currently in use [2,[12][13][14][15][16].…”

“…These include the Score Index for Radiosurgery -SIR [4], Rotterdam scale -RDAM [3], Basic Score for Brain Metastases -BSBM [5], Golden Grading System -GGS [8], Graded Prognostic Assessment -GPA [6,10], Disease Specific GPA -DS-GPA [9] and the German I and II scales developed by Rades et al [7,11]. A recent systematic review of all published systems was not able to definitively identify a superior system [1]; however, a recent neural network analysis suggested that the newly developed RTOG Graded Prognostic Assessment (GPA) system may have some advantage in prognostic utility in the context of WBRT patient populations [19].…”