Brain metastases, survival and recursive partitioning analysis (RPA) our experience

Abstract

Brain metastases are common in cancer, lung it is the most frequent (40% of the total). The Radiationtherapy Oncology Group Recursive Partitioning Analysis (RPA) system classifies the patients according to prognosis factors, (class I: Karnofsky performance status > or = 70%, age < or = 65 years, no extracranial metastases, controlled primary tumor; class III: KPS < 70%; class II: others). Radiation therapy is the usual treatment.Objective. To evaluate overall survival in patients with brain metastases treated with radiotherapy, according the primary tumor and RPA class at a single institution. Material and Methods. We retrospectively analyzed 206 patients with brain metastases diagnosed between January 2007 and December 2011 treated with cranial RT (10 × 3 Gy) at our department. Results. 150 patients (72.82%) lung cancer, 34 patients (16.5%) breast and 8 patients (3.88%) colorectal. 134 males (65.05%) and 72 women (34.95%). RPA: class 1, 42 patients (20.39%), class 2, 137 patients (66.5%) and class 3 27 patients (13.11%). The mean overall survival was 10.73 months (0.1 to 84 months, median 6 months). According to the primary tumor and RPA, mean survivals were: lung class 1, 9.6 months (median 6 months), class 2: 9.18 months (median 6 months) and class 3, 3.34 months (median 2 months). Breast, class 1: 20.25 months (median 18.5), class 2: 17.12 months (median 9 months) and class 3: 15.6 months (median 5 months). In lung cancer the mean of survival was significantly higher among male vs. female 7.35 months vs 12.29 months, p = 0.0053. Conclusions. Only class 1 and 2 and breast cancer seem to have clear benefit with radiotherapy. There was no difference in survival between groups 1 and 2. Despite the use of RT holocraneal, the results are poor and efforts must be made to incorporate the multimodality therapies in patients with more favorable RPA class 1 and 2.http://dx.