Abstract
BackgroundBrain metastases from sarcomatous lesions pose a management challenge owing to their rarity and the histopathological heterogeneity. Prognostic indices such as the Graded Prognostic Assessment (GPA) index have been developed for several primary tumour types presenting with brain metastases (e.g. lung, breast, melanoma), tailored to the specifics of different primary histologies and molecular profiles. Thus far, a prognostic index to direct treatment decisions is lacking for adult sarcoma patients with brain metastases.MethodsWe performed a multicentre analysis of a national group of expert sarcoma tertiary centres (French Sarcoma Group, GSF-GETO) with the participation of one Canadian and one Swiss centre. The study cohort included adult patients with a diagnosis of a bone or soft tissue sarcoma presenting parenchymal or meningeal brain metastases, managed between January 1992 and March 2012. We assessed the validity of the original GPA index in this patient population and developed a disease-specific Sarcoma-GPA index.ResultsThe original GPA index is not prognostic for sarcoma brain metastasis patients. We have developed a dedicated Sarcoma-GPA index that identifies a sub-group of patients with particularly favourable prognosis based on histology, number of brain lesions and performance status.ConclusionsThe Sarcoma-GPA index provides a novel tool for sarcoma oncologists to guide clinical decision-making and outcomes research.
Highlights
Brain metastases from sarcomatous lesions pose a management challenge owing to their rarity and the histopathological heterogeneity
A total of 251 patients with Brain metastasis (BM) of a sarcoma primary fulfilling the study criteria were included in the final analysis (5 patients that were excluded from the initially reported analysis owing to missing data were included in the current analysis as data were retrieved through a second, project-specific data collection as described above)
Presence of extracranial metastases (ECM) was predominant at the time of BM diagnosis (91%), median time to brain metastasis (TTBM) was 18.5 months, whilst median time from first metastasis to development of BM (TMtBM) was 9.6 months
Summary
Brain metastases from sarcomatous lesions pose a management challenge owing to their rarity and the histopathological heterogeneity. Prognostic indices such as the Graded Prognostic Assessment (GPA) index have been developed for several primary tumour types presenting with brain metastases (e.g. lung, breast, melanoma), tailored to the specifics of different primary histologies and molecular profiles. A prognostic index to direct treatment decisions is lacking for adult sarcoma patients with brain metastases. Brain metastasis (BM) in adult sarcoma patients is a rare occurrence [1,2,3] Owing to this rarity, little formal exploration exists in the literature, and evidence-based data is scant. A more recent index, the Graded Prognostic Assessment (GPA) index [8], Table 1)
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