BM-02 * NEW DISEASE SPECIFIC GRADED PROGNOSTIC ASSESSMENT OF BRAIN METASTASIS FROM LUNG, BREAST, MELANOMA AND RENAL MALIGNANCIES

Abstract

BACKGROUND: Brain metastases (BM) are a serious complication of systemic malignancies. Common cancers causing BM include small cell and non-small cell lung cancer (SCLC, NSCLC), breast, melanoma, and renal cancer. The disease-specific Graded Prognostic Assessment (DS-GPA) is a useful tool for evaluating prognosis in these patients. We evaluated the DS-GPA within the context of other clinical factors to see if it could be improved. METHODS: The Cleveland Clinic's IRB approved database was used to identify BM patients treated between 2000 and 2013. The primary endpoint was overall survival (OS) from BM diagnosis. Cox proportional hazards models with stepwise variable selection were used for data analysis. RESULTS: 2247 BM patients were analyzed: NSCLC-50%, breast-20%, melanoma-10%, renal-10%, SCLC-9%. Median age at BM diagnosis was 60 (range, 24-93); 54% were female. Median number of BM was 2 (42% had 1, 25% had >5). Most patients had good performance status (70% had KPS > 80). 43% of patients were treated with whole brain radiotherapy (WBRT), 24% stereotactic-radiosurgery (SRS), 12% WBRT + SRS, 11% surgery + WBRT, 3% surgery + SRS. 84% of patients have died; median OS for the cohort was 8.8 months (95% C.I., 8.1-9.5). DS-GPA was prognostic for each cancer (all p < .0001); however separation between groups was variable. Considering clinical factors not used to determine the DS-GPA, revised indices were developed that improved prognostication. The factors, in addition to DS-GPA, included in the revisions are: breast - number of extra-cranial metastases (ECM), controlled primary (PC), BM location, and leptomeningeal disease; NSCLC - PC, number of ECM, histology, hemorrhagic metastases, and gender; melanoma - number of ECM and age; renal - PC and BM-free interval; SCLC - PC, and number of ECM. Median OS (in months) for the revised GPA groups ranged from 3.1-27.6 (breast), 2.5-26.4 (NSCLC), 2.3-15.4 (melanoma), 3.5-41.6 (renal), and 3.5-15.3 (SCLC). CONCLUSIONS: A revised DS-GPA is proposed.