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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 basic score for brain metastases (BSBM) (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
getmorefigures.php?uid=PMC2666747&req=5

Figure 3: Comparison of median survival in 2 studies using the basic score for brain metastases (BSBM) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).

Mentions: When evaluating the SIR and RPA indices in their SRS database, the group from Brussels, Belgium, arrived at a new score, which they called Basic Score for Brain Metastases (BSBM) [43]. Based on its greater convenience and simplicity, they advocated the use of this score, which uses the same definition of extracranial disease activity as the RTOG. Recent data indicate that BSBM can be applied to patients managed with WBRT with or without SRS and surgery plus WBRT [35,42,44], however its performance is not better than that of the other scores (Figure 3).


Prognostic indices for brain metastases--usefulness and challenges.

Nieder C, Mehta MP - Radiat Oncol (2009)

Comparison of median survival in 2 studies using the basic score for brain metastases (BSBM) (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 3: Comparison of median survival in 2 studies using the basic score for brain metastases (BSBM) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).
Mentions: When evaluating the SIR and RPA indices in their SRS database, the group from Brussels, Belgium, arrived at a new score, which they called Basic Score for Brain Metastases (BSBM) [43]. Based on its greater convenience and simplicity, they advocated the use of this score, which uses the same definition of extracranial disease activity as the RTOG. Recent data indicate that BSBM can be applied to patients managed with WBRT with or without SRS and surgery plus WBRT [35,42,44], however its performance is not better than that of the other scores (Figure 3).

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