title: Radiosurgery for brain metastases: a score index for predicting prognosis.
abstract: OBJECTIVE
  To analyze a prognostic score index for patients with brain metastases submitted to stereotactic radiosurgery (the Score Index for Radiosurgery in Brain Metastases [SIR]).
  
  
  METHODS
  Actuarial survival of 65 brain metastases patients treated with radiosurgery between July 1993 and December 1997 was retrospectively analyzed. Prognostic factors included age, Karnofsky performance status (KPS), extracranial disease status, number of brain lesions, largest brain lesion volume, lesions site, and receiving or not whole brain irradiation. The SIR was obtained through summation of the previously noted first five prognostic factors. Kaplan-Meier actuarial survival curves for all prognostic factors, SIR, and recursive partitioning analysis (RPA) (RTOG prognostic score) were calculated. Survival curves of subsets were compared by log-rank test. Application of the Cox model was utilized to identify any correlation between prognostic factors, prognostic scores, and survival.
  
  
  RESULTS
  Median overall survival from radiosurgery was 6.8 months. Utilizing univariate analysis, extracranial disease status, KPS, number of brain lesions, largest brain lesion volume, RPA, and SIR were significantly correlated with prognosis. Median survival for the RPA classes 1, 2, and 3 was 20.19 months, 7.75 months, and 3. 38 months respectively (p = 0.0131). Median survival for patients, grouped under SIR from 1 to 3, 4 to 7, and 8 to 10, was 2.91 months, 7.00 months, and 31.38 months respectively (p = 0.0001). Using the Cox model, extracranial disease status and KPS demonstrated significant correlation with prognosis (p = 0.0001 and 0.0004 respectively). Multivariate analysis also demonstrated significance for SIR and RPA when tested individually (p = 0.0001 and 0.0040 respectively). Applying the Cox Model to both SIR and RPA, only SIR reached independent significance (p = 0.0004).
  
  
  CONCLUSIONS
  Systemic disease status, KPS, SIR, and RPA are reliable prognostic factors for patients with brain metastases submitted to radiosurgery. Applying SIR and RPA classifications to our patients' data, SIR demonstrated better accuracy in predicting prognosis. SIR should be further tested with larger patient accrual and for all patients with brain metastases subjected or not to stereotactic radiosurgery.
authors.affiliation: Department of Radiation Oncology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. eweltman@einstein.br
authors.forename: E
authors.initials: E
authors.lastname: Weltman
authors.forename: J V
authors.initials: JV
authors.lastname: Salvajoli
authors.forename: R A
authors.initials: RA
authors.lastname: Brandt
authors.forename: R
authors.initials: R
authors.lastname: de Morais Hanriot
authors.forename: F E
authors.initials: FE
authors.lastname: Prisco
authors.forename: J C
authors.initials: JC
authors.lastname: Cruz
authors.forename: S R
authors.initials: SR
authors.lastname: de Oliveira Borges
authors.forename: D B
authors.initials: DB
authors.lastname: Wajsbrot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D016896:Treatment Outcome