Evaluation of three stratification systems predicting recurrence and prognosis in patients with brain metastases after tumor removal and whole-brain irradiation

Abstract

BACKGROUND: To investigate if recursive partitioning analysis (RPA), score index for radiosurgery (SIR) and basic score for brain metastases (BS-BM) can predict survival of patients with brain metastases after tumour removal and whole-brain irradiation. METHODS: 563 patients with brain metastases diagnosed between July 2004 to June 2009 were reviewed. Of these, 62 patients received resection of brain tumours followed by whole-brain irradiation (range 20-30Gy in 4-10 fractions). They were stratified according to RPA, SIR and BS-BM classes. Apart from RPA, SIR and BS-BM, other clinical parameters including age, number of brain metastases, Karnofsky Performance Status, ECOG performance status, time between operation and whole-brain irradiation were also analyzed for any correlation with survival. RESULTS: Mean age of these 62 patients was 57.3 years (25 males and 37 females). The commonest site of the primary was non-small cell lung cancer (33 patients) followed by breast (13 patients) and renal cell carcinoma (7 patients). 21 patients presented with brain metastases at initial diagnosis. 41 patients had solitary metastasis and 12 and 4 patients had two and three brain metastases respectively. 47 patients received resection of all brain tumours and 15 patients received resection of only 1 -2 brain tumours. Median follow up was 12.0 months. Median survival in patients in RPA class I was 15.8 months; RPA class II, 11.0 months. Median survival in patients with BS-BM score 0 is 9.0 months; BS-BM score 1, 11.0 months; BS-BM score 2, 15.1 months; BS-BM score 3, 18.9 months. In univariate analysis, RPA, BS-BM and Score Index for Radiosurgery (SIR) were significant predictors of overall survival (p = 0.016, 0.001 and 0.015, respectively). In multivariate analysis, only BS-SM was the only predictor of overall survival (p = 0.002). CONCLUSIONS: Apart adopted for patients with brain metastases who received radiosurgery, RPA, SIR and especially BS-SM are good predictors of overall survival in those who received tumour removal and whole-brain irradiation. It is feasible to employ these scoring systems to identify patients with short survival.