Diagnosis-specific WBRT-30-CRC Score for Estimating Survival of Patients Irradiated for Brain Metastases from Colorectal Cancer

Abstract

Background/Aim: Existing survival scores for patients with brain metastases were created in heterogeneously treated cohorts. A new score was developed in 56 patients with brain metastases from colorectal cancer treated with 10×3 Gy of whole-brain radiotherapy (WBRT). Patients and Methods: Factors found significantly associated with survival (p<0.05) or showing a trend (p<0.08) were included in the tool. The new WBRT-30-CRC was compared to diagnosis-specific graded prognostic assessment (DS-GPA) classification for gastrointestinal cancers. Results: The WBRT-30-CRC included four prognostic groups: 3-4, 5-6, 7-9 and 10 points. Six-month survival rates were 0%, 15%, 38% and 80%. PPV of the 3-4 points-group predicting death ≤6 months was 100% (91% for DS-GPA of 0.0-1.0). PPV of the 10 points-group predicting survival ≥6 months was 80% (0% DS-GPA of 3.5-4.0, 33% DS-GPA of 3.0-4.0). Conclusion: The WBRT-30-CRC appeared very precise in identifying patients with brain metastases from colorectal cancer dying ≤6 months or surviving ≥6 months. Brain metastases are relatively common and occur in 20-40% of adult cancer patients during their malignant disease (1). Despite the fact that radiosurgery and fractionated stereotactic radiotherapy have become more popular during recent years, many patients with brain metastases receive whole-brain radiotherapy (WBRT) alone, particularly those with more than three lesions, significant comorbidities, or poor 2569 This article is freely accessible online.

An Easy-To-Use Survival Score Compared to Existing Tools for Older Patients with Cerebral Metastases from Colorectal Cancer

“…For the new score, the difference between the 0 points (poor prognosis) and the 1-point group (intermediate prognosis) was significant (p = 0.010, two-tailed Fisher's exact test); a trend (p = 0.087) was found for the difference between the 1-point and the 2-points group (favorable prognosis). The differences between the poor-prognosis and the intermediate-prognosis group was significant for the Evers-Score (p = 0.006) but not for DS-GPA (p = 0.118), WBRT-30-CRC (p = 0.444), or Dziggel-Score (p = 1.000) groups [12][13][14][15][16]. A trend regarding the difference between the intermediate-prognosis and the favorable-prognosis group was found for the WBRT-30-CRC (p = 0.072).…”

“…The 6-month survival probabilities of the prognostic groups of the new score, DS-GPA classification [12,13], Dziggel-Score [14], WBRT-30-CRC [15], and Evers-Score [16] are summarized in Table 3. The positive predictive values (PPVs) for the poor-prognosis groups to accurately identify patients who died within 6 months were 100% (new score), 100% (Evers-Score), 91% (WBRT-30-CRC), 87% (DS-GPA classification) and 86% (Dziggel-Score), respectively.…”

“…It would be ideal to have separate scores for specific cancer types to account for differences in tumor biology and prognoses. A few tools already exist for patients with cerebral metastases from colon or rectal cancers [12][13][14][15]. However, none of these scores has been created specifically for the expanding group of older patients.…”

“…Moreover, the new score was compared to existing instruments, one non-diagnosis-specific and three diagnosis-specific tools, with respect to accurately identifying patients who die within 6 months and patients who survive for 6 months or longer. The diagnosis-specific scores were the diagnosis-specific graded prognostic assessment (DS-GPA) classification for gastro-intestinal cancers, the Dziggel-Score for less radiosensitive tumors, and the WBRT-30-CRC (whole-brain radiotherapy with 30 Gy in 10 fractions for cerebral metastases from colorectal cancer) score [12][13][14][15]. These tools were not specifically created for older patients.…”

Interval Between Cancer Diagnosis and Radiotherapy – An Independent Prognostic Factor of Survival in Patients Irradiated for Bone Metastases from Kidney Cancer

“…Therefore, it is important to identify prognostic factors in patients with bone metastases for each tumor type. This has already been performed for other situations, such as metastatic spinal cord compression (MSCC) and brain metastases (4)(5)(6)(7)(8)(9)(10)(11)(12). The present study was performed to identify independent prognostic factors associated with OS in patients irradiated for bone metastases from kidney cancer.…”