title: Whole brain radiotherapy for poor prognosis patients with brain metastases: predictably poor results.
abstract: BACKGROUND
  Patients with brain metastases from solid tumors can be subdivided by characteristics into separate prognostic groups, such as the Radiation Therapy Oncology Group's Recursive Partitioning Analysis (RPA) or the Graded Prognostic Assessment (GPA). At our institution, patients falling into the poorest prognostic groups are often treated with whole brain radiotherapy (WBRT).
  
  
  OBJECTIVE
  To determine if observed survival of poor prognosis patients treated with WBRT for brain metastases at our institution matches the survival predicted by RPA and GPA prognostic indices.
  
  
  METHODS
  The charts of 101 consecutive patients with newly diagnosed brain metastases from solid tumors who received WBRT were retrospectively reviewed. We calculated each patient's RPA and GPA and compiled treatment and survival data. Observed median survival was compared to that predicted by the RPA and GPA prognostic indices.
  
  
  RESULTS
  RPA III patients (n = 25) had a median survival of 2.4 months in our study. GPA 0.0-1.0 patients (n = 35) had a median survival of 2.4 months in our study. These values did not vary significantly from those predicted by the respective indices.
  
  
  CONCLUSIONS
  This is a retrospective analysis and subject to selection bias.
  
  
  CONCLUSIONS
  Given the delivery time for WBRT and the potential side effects associated with the treatment, the predictably short overall survival in poor prognosis patients calls into question the value of WBRT in this patient subgroup.
authors.forename: Neil C
authors.initials: NC
authors.lastname: Estabrook
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Lutz
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.forename: Mark A
authors.initials: MA
authors.lastname: Henderson
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome