Contemporary Review of the Management of Brain Metastasis with Radiation

Table 2

(a) Median survival according to RPA class following WBRT [26]. (b) RTOG Graded Prognostic Assessment (GPA) is felt to be a more sensitive tool for predicting outcomes in BrM patients. They are assigned a score of 0, 0.5, or 1 for each of 4 characteristics. The sum of the score predicts median survival both as a whole (RTOG MS) and with therapy such as WBRT ± SRS [27]. (c) Disease Specific GPA [28].

(a)

Treatment	Patients ()	Median survival (months) by RPA class
		Class 1; (Primary controlled, age <65, no extracranial metastases, KPS ≥ 70)	Class 2; (primary uncontrolled OR age ≥65, OR extracranial metastases)	Class 3; (KPS < 70)
WBRT (RTOG phase III trials)	1176	7.1	4.2	2.3

(b)

Score	0	0.5	1	Sum GPA score	RTOG MS	WBRT and/or SRS MS
Age	>60	50–59	<50	3.5–4	11.0	21.7
KPS	<70	70–80	90–100	3	6.9	17.5
Number brain mets	>3	2-3	1	1.5–2.5	3.8	5.9
ExtraCNS mets	Present	—	None	0-1	2.6	3.0

MS = median survival (months).

(c)

Primary	Median survival (Months)	95% CI
Non-small-cell lung cancer	7.00	6.53–7.50
Small cell lung cancer	4.90	4.30–6.20
Melanoma	6.74	5.90–7.57
Renal cell carcinoma	9.63	7.66–10.91
Breast cancer	11.93	9.69–12.85
Gastrointestinal cancer	5.36	4.30–6.30
Unknown	6.37	5.22–7.49