title: Evaluation of different score index for predicting prognosis in gamma knife radiosurgical treatment for brain metastasis.
abstract: OBJECTIVE
  To assess the utility of the Radiation Therapy Oncology Group Recursive Partitioning Analysis (RPA) and Score Index for Radiosurgery (SIR) stratification systems in predicting survival in patients with brain metastasis treated with Gamma Knife radiosurgery (GKRS).
  
  
  METHODS
  A total of 185 patients were included in the study. Patients were stratified according to RPA and SIR classes. The RPA and SIR classes, age, Karnofsky Performance Status (KPS), and systemic disease were correlated with survival.
  
  
  RESULTS
  Five patients were lost to follow-up. Median survival in patients in RPA Class 1 (30 patients) was 17 months; in Class 2 (140 patients), 10 months; and in Class 3 (10 patients), 3 months. Median survival in patients in SIR Class 1 (30 patients) was 3 months; in Class 2 (135 patients), 8 months; and in Class 3 (15 patients), 20 months. In univariate testing, age younger than 65 years (p = 0.0004), KPS higher than 70 (p = 0.0001), RPA class (p = 0.0078), SIR class (p = 0.0002), and control of the primary tumor (p = 0.02) were significantly associated with improved outcome. In multivariate analysis, KPS (p < 0.0001), SIR class (p = 0.0008), and RPA class (p = 0.03) had statistical value.
  
  
  CONCLUSIONS
  This study supports the use of GKRS as a single-treatment modality in this selected group of patients. Stratification systems are useful in the estimation of patient eligibility for GKRS. A second-line treatment was necessary in 30% of patients to achieve distal or local brain control. This strategy is useful to control brain metastasis in long-surviving patients.
authors.affiliation: Department of Neurosurgery and Radiosurgery, University Vita-Salute, IRCCS San Raffaele, Milan, Italy. franzin.alberto@hsr.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Franzin
authors.forename: Silvia
authors.initials: S
authors.lastname: Snider
authors.forename: Piero
authors.initials: P
authors.lastname: Picozzi
authors.forename: Angelo
authors.initials: A
authors.lastname: Bolognesi
authors.forename: Carlo
authors.initials: C
authors.lastname: Serra
authors.forename: Alberto
authors.initials: A
authors.lastname: Vimercati
authors.forename: Olga
authors.initials: O
authors.lastname: Passarin
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
mesh_terms: D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000145:classification / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D011832:Radiation Injuries / Q000401:mortality; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate