Limits...
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.

Show MeSH

Related in: MedlinePlus

Comparison of median survival in 2 studies using the graded prognostic assessment (GPA) (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 4: Comparison of median survival in 2 studies using the graded prognostic assessment (GPA) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).

Mentions: The RTOG has recently proposed a new index, which was compared to RPA, SIR, and BSBM (but not to the Rotterdam score) [44]. The new score (Graded Prognostic Assessment (GPA)) is different from RTOG's RPA, e.g., with regard to the number of prognostic classes, which increased from 3 to 4, and the larger number of patients. The analysis also includes patients managed with WBRT plus SRS from RTOG study 9508 [5]. In the GPA system, 3 different values (0, 0.5 or 1) are assigned for each of these 4 parameters: age (≥ 60; 50–59; <50), KPS (<70; 70–80; 90–100), number of brain metastases (>3; 2–3; 1), and extracranial metastases (present; not applicable; none). Assessment of primary tumor activity or control is no longer mandated. It was concluded by the authors that "GPA is the least subjective, most quantitative and easiest to use of the 4 indices" and that future trials should compare these scores and validate the GPA. One of the authors' group has embarked on this comparison in 2 different patient populations, i.e. those managed with WBRT with or without SRS (comparable to the RTOG study population) [42] and those managed with surgery and WBRT [35]. Both studies basically relied on the methods used by the RTOG in their analysis, though with patients treated in clinical routine outside of randomized trials. Compared to RTOG's patients treated with WBRT with or without SRS, the median age, KPS, number of lesions and lesion volume were similar. Obvious differences existed, however, regarding controlled primary tumor (47 vs. 67%) and extracranial metastases (56 vs. 36%). Thus, the cohort is expected to have inferior survival. Figure 4 shows the survival results.


Prognostic indices for brain metastases--usefulness and challenges.

Nieder C, Mehta MP - Radiat Oncol (2009)

Comparison of median survival in 2 studies using the graded prognostic assessment (GPA) (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 4: Comparison of median survival in 2 studies using the graded prognostic assessment (GPA) (treatment was WBRT with or without local measures, studies not limited to one particular cancer type).
Mentions: The RTOG has recently proposed a new index, which was compared to RPA, SIR, and BSBM (but not to the Rotterdam score) [44]. The new score (Graded Prognostic Assessment (GPA)) is different from RTOG's RPA, e.g., with regard to the number of prognostic classes, which increased from 3 to 4, and the larger number of patients. The analysis also includes patients managed with WBRT plus SRS from RTOG study 9508 [5]. In the GPA system, 3 different values (0, 0.5 or 1) are assigned for each of these 4 parameters: age (≥ 60; 50–59; <50), KPS (<70; 70–80; 90–100), number of brain metastases (>3; 2–3; 1), and extracranial metastases (present; not applicable; none). Assessment of primary tumor activity or control is no longer mandated. It was concluded by the authors that "GPA is the least subjective, most quantitative and easiest to use of the 4 indices" and that future trials should compare these scores and validate the GPA. One of the authors' group has embarked on this comparison in 2 different patient populations, i.e. those managed with WBRT with or without SRS (comparable to the RTOG study population) [42] and those managed with surgery and WBRT [35]. Both studies basically relied on the methods used by the RTOG in their analysis, though with patients treated in clinical routine outside of randomized trials. Compared to RTOG's patients treated with WBRT with or without SRS, the median age, KPS, number of lesions and lesion volume were similar. Obvious differences existed, however, regarding controlled primary tumor (47 vs. 67%) and extracranial metastases (56 vs. 36%). Thus, the cohort is expected to have inferior survival. Figure 4 shows the survival results.

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