Validation of the RTOG recursive partitioning analysis (RPA) classification for small-cell lung cancer-only brain metastases.
OBJECTIVE
The Radiation Therapy Oncology Group (RTOG) developed a prognostic classification based on a recursive partitioning analysis (RPA) of patient pretreatment characteristics from three completed brain metastases randomized trials. Clinical trials for patients with brain metastases generally exclude small-cell lung cancer (SCLC) cases. We hypothesize that the RPA classes are valid in the setting of SCLC brain metastases.


METHODS
A retrospective review of 154 SCLC patients with brain metastases treated between April 1983 and May 2005 was performed. RPA criteria used for class assignment were Karnofsky performance status (KPS), primary tumor status (PT), presence of extracranial metastases (ED), and age.


RESULTS
Median survival was 4.9 months, with 4 patients (2.6%) alive at analysis. Median follow-up was 4.7 months (range, 0.3-40.3 months). Median age was 65 (range, 42-85 years). Median KPS was 70 (range, 40-100). Number of patients with controlled PT and no ED was 20 (13%) and with ED, 27 (18%); without controlled PT and ED, 34 (22%) and with ED, 73 (47%). RPA class distribution was: Class I: 8 (5%); Class II: 96 (62%); Class III: 51 (33%). Median survivals (in months) by RPA class were: Class I: 8.6; Class II: 4.2; Class III: 2.3 (p = 0.0023).


CONCLUSIONS
Survivals for SCLC-only brain metastases replicate the results from the RTOG RPA classification. These classes are therefore valid for brain metastases from SCLC, support the inclusion of SCLC patients in future brain metastases trials, and may also serve as a basis for historical comparisons.
Videtic
Gregory M M
GM
Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. videtig@ccf.org
Adelstein
David J
DJ
Mekhail
Tarek M
TM
Rice
Thomas W
TW
Stevens
Glen H J
GH
Lee
Shih-Yuan
SY
Suh
John H
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000145:classification / Q000401:mortality* / Q000556:secondary*; D018288:Carcinoma, Small Cell / Q000145:classification / Q000401:mortality* / Q000556:secondary*; D016371:Cranial Irradiation; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis