title: RPA classification has prognostic significance for surgically resected single brain metastasis.
abstract: OBJECTIVE
  To retrospectively evaluate prognostic factors that correlate with overall survival among patients with a surgically resected single brain metastasis.
  
  
  METHODS
  An Institutional Review Board-approved database of the Cleveland Clinic Brain Tumor Institute was queried for patients with a single brain metastasis treated by surgical resection between February 1984 and January 2004. The primary endpoint was overall survival from the date of surgery by the Kaplan-Meier method.
  
  
  RESULTS
  A total of 271 patients were included. Statistically significant variables for improved survival on multivariate analysis included age <65 years, lack of extracranial metastases, control of primary tumor, histology (non-small-cell lung carcinoma), and use of stereotactic radiosurgery. The median survival for all patients was 10.2 months. Survival of patients in recursive partitioning analysis (RPA) class 1 was better (21.4 months) than those in RPA class 2 (9.0 months, p < 0.001), RPA class 3 (8.9 months, p = 0.15), or the combined group of RPA classes 2 and 3 (9.0 months, p < 0.001). Patients had a median survival of 10.6 months after documented gross total resection and 8.7 months after subtotal resection, which approached statistical significance (p = 0.07). Those who were treated with stereotactic radiosurgery had a median survival of 17.1 months, which was greater than patients who were not treated with stereotactic radiosurgery (8.9 months, p = 0.006).
  
  
  CONCLUSIONS
  This analysis supports the prognostic significance of the RPA classification in patients with a single brain metastasis who undergo surgical resection and adjuvant therapy. RPA class 1 patients have a very favorable prognosis with a median survival of 21.4 months.
authors.affiliation: Department of Radiation Oncology, Brain Tumor Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Rahul D
authors.initials: RD
authors.lastname: Tendulkar
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Liu
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vogelbaum
authors.forename: Steven A
authors.initials: SA
authors.lastname: Toms
authors.forename: Tao
authors.initials: T
authors.lastname: Jin
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis