Retrospective Analysis of Prognostic Factors for Patients With Brain Metastases

Abstract

Aim of the Work: To analyze the factors that affect survival in patients with brain metastases who received whole brain radiotherapy (WBRT) and to evaluate the application of the Graded Prognostic Assessment (GPA) index for these patients. Patients and Methods: We retrospectively analyzed the data of patients who had brain metastases from solid tumors and received WBRT. The impact of different prognostic factors and GPA index on survival of these patients was estimated. Results: Between January 2005 and December 2008, 121 patients with brain metastases were treated with WBRT. The majority of patients were females (64.5%). About 60% of patients were ≥50 years and 67% of patients had a KPS ≥70. The most frequent primary tumors were breast cancer (43%) followed by lung cancer (38.8%) and most patients had extracranial metastases (76.9%).The number of brain lesions exceeded 3 in 52.1% of patients. The median overall survival (OS) was 5.00 months (95% confidence interval (CI) 4.455.55-) and the estimated 1year OS was 19.2% with (95% CI 11.826.7-). The GPA index analysis showed strong correlation with survival (p=0.001), GPA 0,1-3.00 months (95% CI 2.203.80-), GPA 1.55.00 ,2.5-months (95% CI 4.58-5.42), GPA 314 ,4-months (95% CI 11.88-16.12). In univariate analysis significant prognostic factors associated with better survival were: Female sex (p= 0.028), KPS≥70 (p= 0.001), single metastatic lesion (p= 0.034), brain metastases from breast cancer (p=0.001). Multivariate analysis confirmed theses prognostic factors to be significantly associated with better survival. Conclusion: The results of this study confirmed the validity of GPA index to justify its incorporation in future randomized studies on patients with brain metastases. Further examination of the applicability of this index in brain metastases from specific primary tumors is recommended.