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Prognostic indices for brain metastases--usefulness and challenges.

Nieder C, Mehta MP - Radiat Oncol (2009)

Bottom Line: The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool.This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types.Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Department, Division of Oncology, Nordland Hospital, 8092 Bodø, Norway. cnied@hotmail.com

ABSTRACT

Background: This review addresses the strengths and weaknesses of 6 different prognostic indices, published since the Radiation Therapy Oncology Group (RTOG) developed and validated the widely used 3-tiered prognostic index known as recursive partitioning analysis (RPA) classes, i.e. between 1997 and 2008. In addition, other analyses of prognostic factors in groups of patients, which typically are underrepresented in large trials or databases, published in the same time period are reviewed.

Methods: Based on a systematic literature search, studies with more than 20 patients were included. The methods and results of prognostic factor analyses were extracted and compared. The authors discuss why current data suggest a need for a more refined index than RPA.

Results: So far, none of the indices has been derived from analyses of all potential prognostic factors. The 3 most recently published indices, including the RTOG's graded prognostic assessment (GPA), all expanded from the primary 3-tiered RPA system to a 4-tiered system. The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool.

Conclusion: This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types. Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.

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Related in: MedlinePlus

Comparison of median survival in 2 studies using the score index for radiosurgery (SIR) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).
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Figure 2: Comparison of median survival in 2 studies using the score index for radiosurgery (SIR) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).

Mentions: The first attempt in 1999 resulted in the Rotterdam Score, which did not gain wider acceptance [36]. Similar to RPA, performance status and extent of systemic disease were included, while the third parameter was response to steroids before WBRT. It can be assumed that the unavailability of this latter parameter in most databases or patient records prevented other groups from using the score. In addition, the definition of systemic tumor activity is not straight forward. The next attempt (Score Index for Radiosurgery (SIR)) was derived from a limited number of patients treated with this particular focal approach, which might have resulted in overfitting of the data [37]. However, several groups confirmed the performance of the SIR in patients treated with SRS, surgery, and WBRT with or without SRS, some of them with large numbers of patients (Figure 2) [35,38-44]. To accurately define systemic disease activity, comprehensive diagnostic work-up is needed.


Prognostic indices for brain metastases--usefulness and challenges.

Nieder C, Mehta MP - Radiat Oncol (2009)

Comparison of median survival in 2 studies using the score index for radiosurgery (SIR) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2666747&req=5

Figure 2: Comparison of median survival in 2 studies using the score index for radiosurgery (SIR) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).
Mentions: The first attempt in 1999 resulted in the Rotterdam Score, which did not gain wider acceptance [36]. Similar to RPA, performance status and extent of systemic disease were included, while the third parameter was response to steroids before WBRT. It can be assumed that the unavailability of this latter parameter in most databases or patient records prevented other groups from using the score. In addition, the definition of systemic tumor activity is not straight forward. The next attempt (Score Index for Radiosurgery (SIR)) was derived from a limited number of patients treated with this particular focal approach, which might have resulted in overfitting of the data [37]. However, several groups confirmed the performance of the SIR in patients treated with SRS, surgery, and WBRT with or without SRS, some of them with large numbers of patients (Figure 2) [35,38-44]. To accurately define systemic disease activity, comprehensive diagnostic work-up is needed.

Bottom Line: The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool.This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types.Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Department, Division of Oncology, Nordland Hospital, 8092 Bodø, Norway. cnied@hotmail.com

ABSTRACT

Background: This review addresses the strengths and weaknesses of 6 different prognostic indices, published since the Radiation Therapy Oncology Group (RTOG) developed and validated the widely used 3-tiered prognostic index known as recursive partitioning analysis (RPA) classes, i.e. between 1997 and 2008. In addition, other analyses of prognostic factors in groups of patients, which typically are underrepresented in large trials or databases, published in the same time period are reviewed.

Methods: Based on a systematic literature search, studies with more than 20 patients were included. The methods and results of prognostic factor analyses were extracted and compared. The authors discuss why current data suggest a need for a more refined index than RPA.

Results: So far, none of the indices has been derived from analyses of all potential prognostic factors. The 3 most recently published indices, including the RTOG's graded prognostic assessment (GPA), all expanded from the primary 3-tiered RPA system to a 4-tiered system. The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool.

Conclusion: This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types. Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.

Show MeSH
Related in: MedlinePlus