Prognostic factors for brain metastases after whole brain radiotherapy. Data from a single institution.
OBJECTIVE
Prognostic factors for overall survival of patients treated for brain metastases with whole brain radiotherapy (WBRT) at a single institution were retrospectively evaluated, and the validity of the RTOG recursive partitioning analysis (RPA) for prognostic classes was assessed.


METHODS
The data of all patients (n = 268) with brain metastases from solid tumors homogeneously treated between 01/1997 and 09/1999 at the University of Heidelberg, Germany, with WBRT without surgery or radiosurgery were reviewed. 13 different patient- and therapy-related variables were evaluated for prognosis. Second, a grouping of the study cohort was performed according to the RTOG RPA prognostic classes.


RESULTS
Median survival of the whole population after the start of WBRT was 3.8 months. The 1-year survival rate was 19%. Multivariate analysis revealed that only the Karnofsky performance status, control of the primary and no extracranial disease were independent prognostic factors for overall survival. These are also the main determinants of the RTOG RPA classes. Applying the RTOG RPA classes to the authors' data set revealed three subgroups with significantly different prognosis.


CONCLUSIONS
Based on this analysis, prognostic factors for survival after WBRT in patients with brain metastases could be identified. A total of 19% (n = 44/232) survived > or = 1 year, whereas overall survival was poor. The potential value of the RPA classes in estimating the patient's prognosis could be confirmed.
Fleckenstein
Katharina
K
Department of Radiation Oncology, University Hospital Mannheim-University of Heidelberg, Germany. katharina.fleckenstein@radonk.ma.uni-heidelberg.de
Hof
Holger
H
Lohr
Frank
F
Wenz
Frederik
F
Wannenmacher
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000401:mortality* / Q000532:radiotherapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016879:Salvage Therapy / Q000706:statistics & numerical data*; D013534:Survival; D016019:Survival Analysis; D016896:Treatment Outcome