Validation of Nine Different Prognostic Grading Indexes for Radiosurgery of Brain Metastases in Breast Cancer Patients and Development of an All-Encompassing Prognostic Tool

The Usefulness of Prognostic Tools in Breast Cancer Patients with Brain Metastases

“…In 2020, Weykamp et al [ 35 ] developed a new prognostic index for radiosurgery of BM in BC patients: the Breast Cancer Stereotactic Radiotherapy Score (bSRS). The variables included in the score were KPS (≤70 vs. 80 vs. 90–100), HER2 status (negative vs. positive) and ECM (yes vs. no).…”

“…Weycamp et al [ 35 ] in 2020 validated 9 prognostic indices (RPA [ 6 ], Modified RPA [ 14 ], GPA [ 11 ], Breast-GPA [ 24 ], Modified GPA [ 31 ], Updated Breast GPA [ 34 ], SIR [ 8 ], BS-BM [ 9 ] and Point Scoring System [ 30 ]) for SRS in 95 BC patients with BM treated from 2005 to 2016. Only two of them showed a significant c-index: Breast GPA (0.63) and Modified Breast-GPA (0.66).…”

“…Since the first Recursive Partitioning Analysis published in 1997, a series of prognostic tools have been developed in BC patients with newly diagnosed BM to facilitate clinical decision-making and appropriate stratification to local and systemic therapy. This review of prognostic tools illustrates how over time, progress in the understanding of the biology of BC and new effective systemic treatments have influenced the prognosis of patients with BM [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

“…The majority of prognostic tools in BC patients with BM include the performance status, the age at BM diagnosis, the number of BM (rarely volume), the primary tumor phenotype/genotype and the ECM status as an outcome of the systemic therapy efficacy ( Table 3 ) [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Although the results of several analyses agree that patients with better performance status achieve a longer survival, several researchers emphasize that this criterion carries a risk of bias because the clinical assessment of performance status is subjective.…”

“…However, studies assessing ECM status as a prognostic factor used various definitions. Typically, it was the presence of distant metastases outside the brain or their absence [ 22 , 26 , 28 , 30 , 34 , 35 ]. Others analyzed the ECM site (e.g., bone metastases vs. metastases to parenchymal organs or metastases in the liver vs. metastases in other sites) as well as the number of organs outside the brain with metastases [ 6 , 33 ].…”