title: Use of the Graded Prognostic Assessment (GPA) score in patients with brain metastases from primary tumours not represented in the diagnosis-specific GPA studies.
abstract: OBJECTIVE
  Assessment of prognostic factors might influence treatment decisions in patients with brain metastases. Based on large studies, the diagnosis-specific graded prognostic assessment (GPA) score is a useful tool. However, patients with unknown or rare primary tumours are not represented in this model. A pragmatic approach might be use of the first GPA version which is not limited to specific primary tumours.
  
  
  METHODS
  This retrospective analysis examines for the first time whether the GPA is a valid score in patients not eligible for the diagnosis-specific GPA. It includes 71 patients with unknown primary tumour, bladder cancer, ovarian cancer, thyroid cancer or other uncommon primaries. Survival was evaluated in uni- and multivariate tests.
  
  
  RESULTS
  The GPA significantly predicted survival. Moreover, improved survival was seen in patients treated with surgical resection or radiosurgery (SRS) for brain metastases. The older recursive partitioning analysis (RPA) score was significant in univariate analysis. However, the multivariate model with RPA, GPA and surgery or SRS versus none showed that only GPA and type of treatment were independent predictors of survival.
  
  
  CONCLUSIONS
  Ideally, cooperative research efforts would lead to development of diagnosis-specific scores also for patients with rare or unknown primary tumours. In the meantime, a pragmatic approach of using the general GPA score appears reasonable.
authors.affiliation: Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway. cnied@hotmail.com
authors.forename: C
authors.initials: C
authors.lastname: Nieder
authors.forename: N H
authors.initials: NH
authors.lastname: Andratschke
authors.forename: H
authors.initials: H
authors.lastname: Geinitz
authors.forename: A L
authors.initials: AL
authors.lastname: Grosu
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies