Which Prognostic Index Is Most Appropriate in the Setting of Delayed Stereotactic Radiosurgery for Brain Metastases?

Abstract

ObjectivesTo determine if five commonly used prognostic indices (PIs) – recursive partitioning analysis (RPA), Score Index for Radiosurgery (SIR), Basic Score for Brain Metastases (BSBM), graded prognostic assessment (GPA), and the diagnosis-specific GPA – are valid following delay between diagnosis and treatment of brain metastases.MethodsIn a single-institutional cohort, records of patients who underwent stereotactic radiosurgery (SRS) more than 30 days from diagnosis of brain metastases were collected, and five PI scores were calculated for each patient. For each PI, three score-based groupings were made to examine survival differences by means of adjusted log-rank analysis and area under the curve (AUC).ResultsOf 121 patients with sufficient PI information, 72 underwent SRS more than 30 days after diagnosis. Median age and Karnofsky performance status were 60 years and 80, respectively. Forty-three (60%) patients had lung primaries. Prior to SRS, 38 (52.8%) and 12 (16.7%) patients underwent whole brain radiation therapy (WBRT) and surgery, respectively. Two (2.8%) patients underwent both WBRT and surgery prior to SRS. A median of two lesions were treated per SRS course. Median survival of the cohort was 9.0 months. Using adjusted log-rank analysis for pairwise comparison, BSBM and GPA showed significance between two out of the three prognostic groups, while the other scores showed either one or no significant differences on comparison. AUC demonstrated good applicability for BSBM, RPA, and GPA, although SIR was statistically less prognostic than the other PIs.ConclusionThe PIs analyzed in this study were applicable in the setting of delayed SRS. Although these data are hypothesis generating, they serve to encourage further analyses to validate a PI that is most optimal for these patients.

Comprehensive summary and retrospective evaluation of prognostic scores for patients with newly diagnosed brain metastases treated with upfront radiosurgery in a modern patient collective

“…Previous work included fewer scores or combined patient data from a longer time span with the possibility of confounded OS due to differing therapies [22,[46][47][48][49][50][51]. In addition, we provide the first independent external validation for the recently published LabPS [27].…”

Management evaluation of metastasis in the brain (MEMBRAIN)—a United Kingdom and Ireland prospective, multicenter observational study

“…Another reason could be that more surgery is offered to the elderly as an increasing number of otherwise fit patients are referred in an ageing population. 27 There have been efforts to develop new stratification tools such as the Barnholtz-Sloan index 46 , Score Index for Radiosurgery (SIR) and Basic Score for Brain Metastases (BSBM) amongst others 6,47,48 to guide NMDT decision-making for this heterogeneous cohort of patients. These have not been widely adopted into clinical practice for a number of reasons, presumably due to the fact that most of these scores are based on survival data alone without considering other important factors such as quality of life and tumor recurrence.…”