Cranial Metastases Research Articles

Outcomes of stereotactic ablative radiotherapy for extra-cranial oligo-metastatic renal cell cancer.

599 Background: Stereotactic ablative radiotherapy (SAbR) is a standard of care for treating renal cell cancer (RCC) cranial metastasis. We describe the effect of SAbR on oligometastatic extra-cranial RCC disease course. Methods: We retrospectively reviewed 49 patients with oligometastatic RCC with 68 extra-cranial lesions. Patients were treated with SAbR with a curative intent from 2007 to 2017. We analyzed local control, systemic therapy free survival (mPFS), and overall survival. Results: With a median follow-up of 28 months (IQR: 16.0-40.3), the 1-year and 2-year overall survival after SAbR was 93.4% (95% CI: 81.0-97.8), and 83% (95% CI: 67.4-91.5) respectively. The median overall survival was not reached. The median time to systemic therapy was 13.4 months from the first SAbR(95% CI: 8.8-27.6). Median times from the first SabR course to second and third line systemic therapy (or death) were 31.8 months and 45 months, respectively. Patients in the favorable risk group by the Heng’s criteria (HR = 8.67, p = 0.04), with nometastatic disease at diagnosis (HR = 10.38, p < 0.01) and with clear cell histology (HR = 6.15, p < 0.01) exhibited better survival, as shown by univariate analysis. Patients with no metastatic disease at diagnosis (HR = 2.56, p = 0.02) and only one metastasis treated with SAbR (HR = 2.36, p = 0.03) also exhibited better systemic therapy-free survival. SAbR had an excellent local control rate of 94% at 2 years with no reported grade 3 or higher toxicity. Conclusions: SAbR is an effective and safe treatment for oligometastatic RCC, offering excellent local control with minimal toxicity. SAbR delayed the start of systemic therapy for this RCC cohort, offering quality of life benefits for patients without adversely affecting the progression on subsequent lines of systemic therapy. These findings call for prospective verification.

Updated risk models demonstrate low risk of symptomatic radionecrosis following stereotactic radiosurgery for brain metastases.

Background:Improvements in systemic therapy continue to increase survival for patients with brain metastases. Updated dosimetric models are required to optimize long-term safety of stereotactic radiosurgery (SRS) for this indication.Methods:Patients at a single institution receiving SRS from December 2011 to December 2014 were retrospectively reviewed. Patients with radiographic progression of at least one lesion, and with at least 6 months of follow-up from the start of SRS were included. Grade 3 necrosis was defined as requiring surgical intervention. This data were combined with two additional published datasets to construct logistic models describing necrosis risk as a function of dose and volume.Results:From our institution, 294 brain metastases across 57 patients in 139 treatment plans met inclusion criteria. Primary histologies included non-small cell lung cancer (n = 19), melanoma (n = 13), breast carcinoma (n = 9), renal cell carcinoma (n = 7), and other (n = 9). Median follow-up from SRS of first cranial metastasis was 21.7 months (range: 6.3–56.6) and median overall survival was 25.6 months (range: 6.5–56.6). There were eight cases of Grade 1–2 and two cases of Grade 3 necrosis. As a useful clinical reference point, 20 cc of total brain receiving a single-fraction equivalent dose ≥14 Gy corresponded to 12.1% risk for Grade 1–3 (P < 0.003) and 3.4% risk for Grade 3 necrosis (P < 0.001).Conclusions:These results compare favorably with the QUANTEC brain tolerance estimates for radiosurgery, providing optimism for lower toxicity in the modern era. Additional studies are needed to determine dose tolerance parameters across a broad spectrum of patients.

EXTRACRANIAL METASTASIS OF GLIOBLASTOMA: A RARE CASE

Glioblastoma is the most common primary malignant tumor in the neural tissue and a highly aggressive primary tumor in human. It involves glial cells in 52% of functional brain tissue cases and 20% of all intracranial tumors. Extra cranial metastasis of Glioblastoma is very rare. Metastasis outside CNS was uncommon in GBM but it could occur with frequency 0.2% and can spread in head and neck sites. The mechanism of this spread is not understood yet. The extracranial spread routes were speculated on the direct lymphatic connections, the venous system and the adjacent structure like dura and bone. We present a case of female patient with a known glioblastoma who had an extracranial metastasis on her left neck with complete Radiotherapy n Chemotherapy and survive more than 2 years.

Safety and Efficacy of Oki Stenting Used to Treat Obstructions in the Right Mainstem Bronchus.

Silicone stenting has been used to palliatively manage respiratory symptoms in patients with airway stenoses. Oki and Saka recently developed stents that can be used to manage stenoses around the carina between the bronchus to the right upper lobe and the bronchus intermedius (termed the primary right carina). The aim of this study was to assess the efficacy and safety of Oki stenting used to treat airway stenosis around the primary right carina. We included 5 patients with airway stenoses. All Oki stenting procedures were performed with the patients under general anesthesia using either rigid or flexible bronchoscopy. Oki stents were successfully placed in all 5 patients, and the dyspnea index improved in all. Modified Oki stenting was performed at the anastomotic site of 1 patient who had undergone sleeve resection. Four patients had airway obstructions caused by malignant disease. No serious procedural or early complication was noted. One patient died of liver insufficiency, and another with a malignancy died from cranial metastasis of the primary tumor. Oki stenting of the primary right carina is safe, efficient, and acceptable when used for palliative management of airway obstruction, even after sleeve resection; in the latter case, some procedural modifications are required.

Outcomes and prognostic factors in thyroid cancer patients with cranial metastases: A retrospective cohort study of 4,683 patients

BackgroundCranial metastasis of thyroid cancer is rare. The aim of this study was to analyse the clinical characteristics, treatments and outcomes of thyroid cancer patients with cranial metastasis and to identify the associated prognostic factors. Materials and methodsBetween January 1977 and August 2017, a total of 4683 patients were histologically confirmed to have thyroid cancer. Among them, 25 patients (0.53%) were identified as having cranial metastases, and their medical records were reviewed. The Kaplan-Meier method with a log-rank test was performed with cancer-specific survival as the main outcome. Cox regression analysis was used to examine the potential prognostic factors influencing patient survival. ResultsOf the 25 patients, 21 were female, and 4 were male. The median age at the time of diagnosis of cranial metastasis was 63 years. Sixteen patients had metastases to the brain, and nine patients had metastases involving the skull only. Papillary carcinoma and follicular carcinoma accounted for 84.0% of cases. Twenty-four cases (96.0%) had extracranial metastases at the time of diagnosis of cranial metastases. Twenty patients received surgery, and 4 patients received palliative radiotherapy. One patient received supportive care only. The median cancer-specific survival after the diagnosis of cranial metastases was 27 months. According to the Kaplan-Meier test, 3 factors had a significant impact on survival, the metastatic site, histological types and surgical resection. According to the Cox regression analysis, skull metastases (HR: 0.274, 95% CI: 0.083–0.904, p = 0.033) and surgical resection (HR: 0.134, 95% CI: 0.019–0.929, p = 0.042) were identified as independent prognostic factors for a better outcome. ConclusionsSurgical resection is the mainstay therapy for thyroid cancer patients with cranial metastasis. Cranial metastases involving the skull only are associated with a better outcome.

Controversies and progresses in prophylactic cranial irradiation for small cell lung cancer

Small cell lung cancer (SCLC) is a kind of highly invasive malignant neoplasm, which is characterized by short survival and high-risk cranial metastasis. Therefore, application of prophylactic cranial irradiation (PCI) is of clinical significance to reduce the incidence of brain metastasis and prolong the patients’ survival on the basis of radio-and chemo-therapy. Nevertheless, the indications and clinical value of PCI have been controversial in recent years. These controversies mainly include the significance of PCI for extensive-stage SCLC, the indications of PCI for limited-stage SCLC and the alternative approaches for PCI. In this paper, the controversies and progresses of PCI applied in clinical practice are investigated and reviewed. Key words: Carcinoma, small cell lung/prophylactic cranial irradiation; Progress

Vanishing a primary lung carcinoma following irradiation of cranial metastasis: “the abscopal effect”

Vanishing a primary lung carcinoma following irradiation of cranial metastasis: “the abscopal effect”

Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients.

ABSTRACTPurpose Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series.Patients and methods We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013.Results Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months.Discussion and conclusion Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.

Outcome after craniotomy for recurrent cranial metastases

Objective: To investigate the outcomes of patients with recurrent/progressive cranial metastases who underwent re-do craniotomy and to assess the utility of surgery as a treatment option.Methods: A retrospective study was conducted assessing survival after re-do craniotomy for recurrent or progressive cranial metastases. 29 patients were identified between January 2006 and December 2013. Data was gathered from a prospective pathology database, patients’ notes and electronic records. The diagnosis of cranial metastasis was obtained through pathological analysis at the time of tumour resection. Results were analysed with Cox regression tests and converted into a Kaplan–Meier curve.Results: Median patient age was 57 years old (range 24–74 years) at diagnosis of brain metastases. Two patients had serious complications after re-do surgery. Five patients had >2 craniotomies for recurrent disease. Median survival after the first craniotomy was 18 months (range 4.1–50.9 months). Median survival after re-do craniotomy was 7.6 months (range 0.2–31.3 months). 90% of patients survived at least 3 months after re-do surgery, 65.5% survived at least 6 months.Conclusion: This study suggests that re-do surgery is a viable treatment option for patients with recurrent cranial metastases.

A 'silent' skull metastatic follicular thyroid carcinoma mimicking as a benign scalp tumor in a pregnant woman.

SummaryThyroid cancer with cranial metastasis in a pregnant woman is very rare. In the literature, most cases are diagnosed early from neurogenic signs or symptomatic thyroid gland. Pregnancy also contributes to a hesitation toward early surgical and medical treatments. We reported a scalp tumor in a physically healthy 37-year-old pregnant female with a follicular thyroid carcinoma (FTC) with lung, bone and cranial metastasis in initial presentation. Silent neurogenic and physical examinations make an early diagnosis very challenging. Resection of scalp and intracranial tumor, a thyroidectomy, post-operative radioactive iodine therapy and tyrosine kinase inhibitors were employed as treatment. The scalp tumor was confirmed as a metastatic follicular thyroid carcinoma via positive immunoreactivity for thyroglobulin and thyroid transcription factor 1 in tumor cells. Blood examination revealed an elevated thyroglobulin level (>5335 ng/mL). The patient was discharged without any neurological deficit. An asymptomatic scalp tumor in a pregnant woman with a normal thyroid disease history needs differential diagnosis from intracranial origin. Rapid progression and an elevated thyroglobulin level are the indicators that further image study is needed. Aggressive surgical excision of resectable thyroid gland and metastatic tumor are essential for a longer survival rate. There is nothing to indicate that a post-partum operation will worsen prognosis.Learning points:Follicular thyroid cancer with cranial metastasis in initial presentation can be asymptomatic.Follicular thyroid cancer with cranial metastasis in a pregnant woman can be treated after delivery.Rapid enlargement of scalp tumor is indicated for further image study even in a patient without any neurological deficit.

A Silent and Debilitating Case of Obstructing Hydrocephalus

Background: Leptomeningeal metastases are complications of advanced cancer and have a scarce but often death-dealing incidence. Diagnosis often requires a good measure of suspicion and patients can present with a vast diversity of signs and symptoms. Case presentation: A 76-year-old male who comes in with altered mental status of unknown etiology with past medical history significant for multiple types of cancer and recent travel to Vancouver. He was investigated by our internal medicine team for altered mental status, pulmonology for a possible pneumonia, neurology for possible HSV encephalitis vs. cranial metastases and infectious disease for a new onset rash on his torso. Conclusion: Metastasis was diagnosed through spinal fluid cell analysis and patient was sent to hospice.

P3.02b-013 Evaluation of Lung Specific GPA Score in Adenocarcinoma Patients with Brain Metastasis and EGFR Activating Mutation: Topic: EGFR Biomarkers

The lung specific GPA score is an index, commonly used for patients with non-small cell lung carcinoma (NSCLC) and brain metastasis (BM) in order to predict overall survival (OS) with the help of four easy-to-use items: age at the diagnosis of the brain metastasis; Karnofsky Performance Status (KPS), presence of extra cranial metastasis (ECM) and number of brain metastasis (Sperduto PW et al. J Clin Oncol 2012; 30:419-25). However, this tool might not be appropriate to patients harboring EGFR activating mutations, which are known to have better prognosis than those with no activating mutations. The goal of our study was to determine if the Lung specific GPA score is adapted to population with these mutations. We retrospectively analyzed 108 Caucasians patients diagnosed with NSCLC between 2000 and 2014. Clinical features, systemic treatments (chemotherapy or EGFR tyrosine kinase inhibitors) and local brain treatment (Whole Brain Radiotherapy (WBRT) or surgery or Stereotactic Radiosurgery (SRS) were examined. OS were compared to the expected OS according to the lung specific GPA score as described by Sperduto. Ninety-eight patients (91%) had EGFR activating mutations, whereas 10 (9%) were undetermined. 69% of them were nonsmokers. 77/108 patients (71.3%) were woman. 53/108 patients (49%) had BM: 30 patients had synchronous BM whereas 23 patients had metachronous BM. 20/53 patients (38%) were treated with WBRT. BM is still a burden for NSCLC patients harboring EGFR activating mutations, (median OS 42 vs 25.5 months, p = 0.0052). OS from BM diagnosis was significantly superior in patients with EGFR activating mutations, compared to the expected OS in accordance with Sperduto’s GPA score (1): group 0-1 (11.5 months IC 95% [8.5-25.7] vs 3.02 months IC 95% [2.63-3.84]); group 1.5-2 (28 months IC 95% [24.3-NR] vs 5.49 months IC 95% [4.83-6.40]) (p = 0.026). Among EGFR activating mutations, OS were also significantly longer in group 1.5-2 than in group 0-1 (28 vs 11.5 months) (p = 0.026). Currently, Lung specific GPA is not accurate enough to estimate survival time for EGFR mutant patients. However, this tool is still reliable to distinguish different prognosis for patient with EGFR activating mutations, according to their GPA score. In conclusion, EGFR status modifies OS of patients and should be integrated in the items of the GPA score. These results should be validated in further prospective studies.

EP-1700: SRS treatment planning for multiple cranial metastasis with a single isocentre approach using VMAT

EP-1700: SRS treatment planning for multiple cranial metastasis with a single isocentre approach using VMAT

Long term palliation of a metastatic primary gliosarcoma with stereotactic body radiotherapy

Primary gliosarcoma (PGS) is rare and is known for extra cranial metastases. The overall outcome is dismal and hence the focus is on providing the best quality of life. This report describes a seventy-year-old lady who at presentation had metastatic primary gliosarcoma with intractable cough. Her lung lesion was treated with stereotactic body radiotherapy (SBRT) to a dose of 10 Gy per fraction for three consecutive days. She was free of cough till her death at eighteen months after treatment. This is probably the first reported case of excellent long-term quality of life in a patient of metastatic primary gliosarcoma.

Third nerve paralysis due to cranial metastasis of prostate tumor

A 90 years old man presented with outward deviated right eye with droopy lid. These symptoms were developed over a period of two weeks and there was no pain behind the eye. There was no previous history of Diabetes mellitus, hypertension etc. He had a treatment for adenocarcinoma of prostate six years ago. On examination his best-corrected visual acuity was 6/60 in each eye. There was right complete third nerve paralysis with pupil involvement. Anterior segment examination showed nucleosclerotic changes on both sides. Posterior segment examination showed ARMD (dry type) in both eyes. Intraocular pressure and discs were normal. Contrast enhanced MR scan brain revealed a destructive mass at the base of skull at petrous apex on the right side extending forward to orbital apex on the same side. Total body bone scan also showed multiple metastatic lesions. Patient was referred to oncology unit for further management

The Role of Peritumoral Perfusion Values in Differentiation of Multicentric Glial Tumors and Cranial Metastasis

Introduction: Although MRI is the primary modality in the diagnosis of cranial metastasis, advanced MRI techniques such as spectroscopy, perfusion, diffusion weighted imaging, and diffusion tensor imaging are used to distinguish cranial metastasis from other pathologies. Since cranial metastasis are often highly vascular lesions, on perfusion examination they tend to exhibit elevated cerebral blood volume (rCBV). However since high-grade glial tumors also exhibit elevated rCBV, perfusion imaging cannot accurately differentiate between these two groups. Peritumoral rCBV values are actually more reliable in differential diagnosis of multicentric glial tutors and cranial metastasis. Case report: A fifty-six-year-old male presented with progressive weakness in his left arm. MRI revealed multiple, different-sized lesions with a wide range of intensity changes. Some of the lesions displayed substantial peritumoral vasogenic edema. On DWI sequences, lesions demonstrated peripheral restricted diffusion. MRP sequences didn't show elevated rCBV values in T2-hyperintense peritumoral edema areas. The excisional biopsy of the lesion in left occipital lobe performed and the lesion's pathology result was reported as small-cell lung carcinoma metastasis, supporting our primary radiologic diagnosis. Discussion: Advanced MRI techniques such as perfusion, spectroscopy, diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are used in the context of distinguishing cranial metastasis from high-grade glial tumors. Perfusion parameters like rCBV and rCBF are important to distinguish metastatic lesions from cranial lymphoma and benign cranial masses like abcess. However, since both cranial metastasis and high-grade glial lesions are both hypervacular, comparison of rCBV of the enhancing component of lesions cannot differentiate between these two groups. In such cases, rCBV values obtained from the peritumoral T2 hyperintense edema component of the lesion can help us. Conclusion: Multicentric glial tumors are on the differential diagnosis list of cranial metastasis. When conventional MRI techniques are insufficient to differentiate these two entities, perfusion values obtained from the peritumoral edema areas might be helpful.

嚥下障害を契機に頭蓋骨転移と診断された再発膵癌の1例

嚥下障害を契機に頭蓋骨転移と診断された再発膵癌の1例

Metastatic Prostate Cancer Masquerading as a Primary Sinus Tumor

Advanced prostate cancer commonly manifest with obstructive uropathy, regional lymphatic and axial skeleton metastases. Cranial metastases to the paranasal sinuses are extremely rare [1,2]. A 63-yearold male presented with a three-month history of progressive blurred vison and headache

Trastuzumab-based Retreatment after Lapatinib in Heavily Pretreated HER2 Positive Metastatic Breast Cancer: an Anatolian Society of Medical Oncology Study.

For HER2 positive metastatic breast cancer (MBC), continuing anti-HER2 therapy beyond progression is associated with improved outcome. However retreatment with trastuzumab after lapatinib progression is controversial. We retrospectively analyzed the efficacy of trastuzumab-based chemotherapy in HER2+ metastatic breast cancer patients whose disease progressed after lapatinib. Between October 2010 and May 2013, 54 patients whose disease progressed after lapatinib were retreated with trastuzumab-based chemotherapy. Efficacy and toxicity results were evaluated retrospectively. The median age of patients was 46 (range 27-67). Fourteen patients (26%) had metastases at the time of diagnosis. All of the patients had received trastuzumab in an adjuvant or metastatic setting, while 16 (30%) had received two lines of trastuzumab. All patients had received lapatinib plus capecitabine. The median chemotherapy line for the metastatic setting was 2 (range 1-7). Cranial metastases were identified in 27 (50%) patients. 53 patients received trastuzumab-based chemotherapy following lapatinib progression while one patient received trastuzumab monotherapy. Combination chemotherapy consisted of navelbin (n=33), taxane (n=10), gemcitabine (n=2), platinum (n=2) and platinum with taxane (n=6). The median treatment cycle was 5 (range 1-44). Among 49 patients assessed for response 2 (4%) showed CR, 12 (25%) PR, 11 (22%) SD and 24 (49%) disease progression. Asymptomatic cardiotoxicity was reported in 2 (4%) of the patients. At a median follow-up of 9 months (1-39), median progression-free survival was 5 months (95% CI 4.1-5.9) and median overall survival was 10 months (95% CI 6.9-13.0). PFS and OS were not affected by the absence/presence of cranial metastases. Retreatment with trastuzumab-based therapy after lapatinib progression showed efficacy in heavily treated MBC patients.

Abstract P6-16-05: New graded prognostic assessment (GPA) in breast cancer brain metastases in a contemporary cohort

Abstract Background: Breast cancer is the second most common cause of brain metastases (BCBM). We evaluated prognostic factors for overall survival (OS) in contemporary cohort of BCBM patients treated at a tertiary care institution. Methods: With IRB approval, Cleveland Clinic’s database was used to identify BCBM patients treated between 2000 and 2013. OS from the diagnosis of BCBM was the primary end point. Cox proportional hazards models with stepwise variable selection were used for data analysis. Results: 562 female patients were included for this analysis. Karnofsky performance scale (KPS) was 90-100 in 204 patients (41%), 70-80 in 223 (44%) and &amp;lt;70 in 76 (15%) patients. Two hundred, eighty nine (52%) patients were treated with whole brain radiation therapy (WBRT), 89 (16%) with stereotactic radiosurgery (SRS), 66 (12%) with WBRT and SRS, 44 (8%) underwent surgery and WBRT, 16 (3%) underwent surgery and SRS. Median OS for the entire cohort was 11.2 months (95% C.I., 10.0-13.1). Median OS in Luminal B (triple positive), Her 2 positive, Luminal A (ER/PR positive, Her 2 negative) and basal (triple negative) patients was 23.3, 14.5, 10.0 and 8.3 months respectively. Disease specific graded prognostic assessment (GPA) for BCBM is based on KPS, age at diagnosis, and subtype. Overall it was prognostic for OS (p &amp;lt;.0001), however separation between groups was variable. Starting de-novo, KPS, age at diagnosis of BCBM, and subtype were again identified as prognostic, although the scoring was different. Additional independent predictors were the number of sites of extra- cranial metastases, leptomeningeal disease, control of primary cancer and location of BCBM were found to be independently prognostic for survival. A new GPA was formulated by assigning "points" (weights) to the levels within each of these seven factors that are proportional to the regression coefficient estimates in the final model and then adding the total number of points present. Prognostic factors in BCBM on multivariate analysisFactorPointsHazard RatiopKPS 0.41 (0.32-0.52)&amp;lt;0.00180-10013 &amp;lt;700 Breast Cancer Subtype ( basal as reference) Luminal B100.49 (0.32-0.74)&amp;lt;0.001HER280.58 (0.43-0.77)0.007Luminal A60.63 (0.48-0.77)0.002Basal0 Number of sites of Extra-Cranial Metastases 0.65 (0.56-0.77)&amp;lt;0.0010 or 112 2-34 &amp;gt;30 Leptomeningeal Disease 0.51 (0.38-0.67)&amp;lt;0.001No10 Yes0 Primary Controlled 0.68 (0.53-0.88)0.003Yes5 No0 Age at Diagnosis of BCBM 0.75 (0.59-0.96)0.02&amp;lt;504 &amp;gt;/=500 Location of Brain Metastasis 0.76 (0.61-0.96)0.02Infratentorial or Supratentorial4 Both0 The new GPA consists of four groups: unfavorable, intermediate 1, intermediate 2 and favorable with OS of 2.7, 9.1, 18.5 and 29.5 months respectively. New GPA and Conventional GPANew GPAGroupNumber of pointsNumberMedian OS (months)Unfavorable&amp;lt;/=2184 (19%)2.7Intermediate-122-36153 (34%)9.1Intermediate-237-45133 (30%)18.5Favorable&amp;gt;4578 (17%)29.5Conventional GPAUnfavorable0-155 (12%)4.8Intermediate-11.5-2130 (29%)9.1Intermediate-22.5-3148 (33%)12.9Favorable3.5-4116 (26%)20.4 Conclusions: A new GPA for BCBM is proposed. Citation Format: Manmeet S Ahluwalia, Ming Chi, Vyshak Alva Venur, Thomas Budd, Lilyana Angelov, Samuel Chao, Paul Elson, Gene H Barnett, Jame Abraham. New graded prognostic assessment (GPA) in breast cancer brain metastases in a contemporary cohort [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-16-05.