Radiosurgery for brain metastases: a score index for predicting prognosis

Weltman, Eduardo; Salvajoli, João Víctor; Brandt, Reynaldo André; Hanriot, Rodrigo de Morais; Prisco, Flavio E.; Cruz, José C.; Borges, Sandra Regina de Oliveira; Wajsbrot, Dalia

doi:10.1016/s0360-3016(99)00549-0

Cited by 363 publications

(260 citation statements)

References 32 publications

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“…The published data definitively indicate the prognostic value of KPS; in the majority of publications, the statistically significant adverse prognostic factor is a KPS below 70 [5-8, 14, 16, 17, 30, 32-36], whilst in other publications, this concerns a KPS below 80 [7,32,33]. Table VI presents the values of average survival periods of patients with MBM depending on the KPS score, which were 5.9-6.3 months for KPS ≥ 70 and were definitely lower in patients with a poorer general performance (KPS < 70), where they varied from 1.8 to 3.8 months.…”

Section: Discussionmentioning

confidence: 99%

“…The other, generally accepted prognostic factor is the number of MBM foci. The best prognoses concerned the patients with a single metastatic focus [17,32,35,36,40]; the increase of the MBM number is associated with a deterioration of the patient's prognosis [17,32,35,36].…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness of brain metastases radiotherapy in patients with melanoma

Szyszka-Charewicz

2017

Nowotwory. Journal of Oncology

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Introduction. Melanoma gives rise to 7-13% brain metastases (MBM -melanoma brain metastases) and is ranked third leading cause of brain metastases. The prognosis of patients with MBM is poor, with a median survival time of 3-6 months. Assessment of the value and limitations of three prognostic scores used in patients with melanoma brain metastases (MBM) was presented in this paper. Material and methods. In 110 patients with MBM, we executed an analysis of prognostic factors. All patients were treated with radiotherapy: whole brain radiotherapy performed as a treatment method in combination with chemotherapy (14 patients -12.7%), neurosurgery (12 patients -10.9% or stereotactic radiosurgery (8 patients -7.3%). Results. The median overall survival (OS) from diagnosis MBM was 4.8 months (95% CI 4.1-5.2 months). The analyses showed that the Karnofsky Performance Status and number of the MBM are independent significant prognostic factors. The analyses of OS, as a function of prognostic scores, showed that in the class with the best prognosis median OS was similar (7.2-10.7 months); and in the class with the worse prognosis median OS was also similar (range, 2.6-4.3 months). Conclusions. Our observations and data from literature showed that the presented scores can: distinguish classes of patients by prognosis before treatment, guide the choice of treatment methods and help design strategies for patient selection in clinical trials but they did not fully discriminate between unfavourable groups. NOWOTWORY J Oncol 2016; 66, 5: 367-374

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effectiveness of brain metastases radiotherapy in patients with melanoma

Szyszka-Charewicz

2017

Nowotwory. Journal of Oncology

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“…10,[36][37][38] The Graded Prognostic Assessment has recently been shown to also predict survival in the salvage SRS setting. 39 Variables, such as patient age, KPS, cancer histology, number of metastases, and systemic disease status, which predict for regional brain failure and WBRT-free survival after initial SRS, are also likely useful in the context of salvage treatments.…”

Section: Discussionmentioning

confidence: 99%

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Rae

Gorovets

Rava

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Many patients treated with stereotactic radiosurgery (SRS) alone as initial treatment require 1 or more subsequent salvage therapies. This study aimed to determine if commonly used salvage strategies are associated with differing risks of radiation necrosis (RN). Methods and materials: All patients treated with upfront SRS alone for brain metastases at our institution were retrospectively analyzed. Salvage treatment details were obtained for brain failures. Patients who underwent repeat SRS to the same lesion were excluded. RN was determined based on pathological confirmation or advanced brain imaging consistent with RN in a symptomatic patient. Patients were grouped according to salvage treatment and rates of RN were compared via Fisher's exact tests. Results: Of 284 patients treated with upfront SRS alone, 132 received salvage therapy and 44 received multiple salvage treatments. This included 31 repeat SRS alone, 58 whole brain radiation therapy (WBRT) alone, 28 SRS and WBRT, 7 surgery alone, and 8 surgery with adjuvant radiation. With a median follow-up of 10 months, the rate of RN among all patients was 3.17% (9/284), salvaged patients 4.55% (6/132), and never salvaged patients 1.97% (3/152). Receiving salvage therapy did not significantly increase RN risk (P Z .31). Of the patients requiring salvage treatments, the highest RN rate was among patients that had both salvage SRS and WBRT (delivered as separate salvage therapies) (6/28, 21.42%). RN rate in this group was significantly higher than in those treated with repeat SRS alone (0/31), WBRT alone (0/58), surgery alone (0/7), and surgery with adjuvant radiation (0/8). Comparing salvage WBRT doses <30 Gy versus 30 Gy revealed no effect of dose on RN rate. Additionally, among patients who received multiple SRS treatments, number of treated lesions was not predictive of RN incidence. Conclusion: Our results suggest that initial management approach for recurrent brain metastasis after upfront SRS does not affect the rate of RN. However, the risk of RN significantly increases when patients are treated with both repeat SRS and salvage WBRT. Methods to improve prediction of toxicity and optimize patient selection for salvage treatments are needed.

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Radiosurgery for Single and Multiple Brain Metastases

Mehta¹,

Tremont‐Lukats²

2004

Intracranial Metastases

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Radiosurgery for brain metastases: a score index for predicting prognosis

Cited by 363 publications

References 32 publications

The effectiveness of brain metastases radiotherapy in patients with melanoma

The effectiveness of brain metastases radiotherapy in patients with melanoma

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Radiosurgery for Single and Multiple Brain Metastases

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