title: A validation study of a new prognostic index for patients with brain metastases: the Graded Prognostic Assessment.
abstract: OBJECTIVE
  The purpose of this study was to validate a new prognostic index for patients with brain metastases. This index, the Graded Prognostic Assessment (GPA), is based on an analysis of 1960 patients whose data were extracted from the Radiation Therapy Oncology Group (RTOG) database. The GPA is based on 4 criteria: age, Karnofsky Performance Scale score, number of brain metastases, and the presence/absence of extracranial metastases. Each of the 4 criteria is given a score of 0, 0.5, or 1.0, so the patient with best prognosis would have a GPA score of 4.0.
  
  
  METHODS
  Between April 2005 and December 2006, 140 eligible patients with brain metastases were treated at the Gamma Knife Center at the University of Minnesota. The GPA score was calculated for each patient, and the score was then correlated with survival. Survival duration was calculated from the date treatment began for the brain metastases. Eligibility criteria included patients treated with whole-brain radiation therapy, stereotactic radiosurgery, or both.
  
  
  RESULTS
  The median survival time in months observed in the RTOG and Minnesota data by GPA score was as follows: GPA 3.5-4.0, 11.0 and 21.7; GPA 3.0, 8.9 and 17.5; GPA 1.5-2.5, 3.8 and 5.9; and GPA 0-1.0, 2.6 and 3.0, respectively.
  
  
  CONCLUSIONS
  The University of Minnesota data correlate well with the RTOG data and validate the use of the GPA as an effective prognostic index for patients with brain metastases. Clearly, not all patients with brain metastases have the same prognosis, and treatment decisions should be individualized accordingly. The GPA score does appear to be as prognostic as the RPA and is less subjective (because the RPA requires assessment of whether the primary disease is controlled), more quantitative, and easier to use and remember. A multi-institutional validation study of the GPA is ongoing.
authors.affiliation: Minneapolis Radiation Oncology, University of Minnesota Gamma Knife Center, Minneapolis, Minnesota 55113, USA.
authors.forename: Christina Maria
authors.initials: CM
authors.lastname: Sperduto
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Watanabe
authors.forename: John
authors.initials: J
authors.lastname: Mullan
authors.forename: Terry
authors.initials: T
authors.lastname: Hood
authors.forename: Gregg
authors.initials: G
authors.lastname: Dyste
authors.forename: Charles
authors.initials: C
authors.lastname: Watts
authors.forename: Gail Papermaster
authors.initials: GP
authors.lastname: Bender
authors.forename: Paul
authors.initials: P
authors.lastname: Sperduto
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D016208:Databases, Factual; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome