Predicting Survival with Brain Metastases in the Stereotactic Radiosurgery Era: are Existing Prognostic Scores Still Relevant? Or Can we do Better?

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2024-05, Vol.36 (5), p.307-317
• Main Authors: Fittall, M.W., Brewer, M., de Boisanger, J., Kviat, L., Babiker, A., Taylor, H., Saran, F., Konadu, J., Solda, F., Creak, A., Welsh, L.C., Rosenfelder, N.
• Format: Article
• Language: English
• Subjects: Brain metastases; prognostic score; radiosurgery; stereotactic; survival
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2024.01.037

Predicting survival is essential to tailoring treatment for patients diagnosed with brain metastases. We have evaluated the performance of widely used, validated prognostic scoring systems (Graded Prognostic Assessment and diagnosis-specific Graded Prognostic Assessment) in over 1000 ‘real-world’ patients treated with stereotactic radiosurgery to the brain, selected according to National Health Service commissioning criteria. Survival outcomes from our dataset were consistent with those predicted by the prognostic systems, but with certain cancer subtypes showing a significantly better survival than predicted. Although performance status remains the simplest tool for prediction, total brain tumour volume emerges as an independent prognostic factor, and a new, improved, prognostic scoring system incorporating this has been developed. •Real-world data for patients with brain metastases are consistent with the predictions made by the prognostic tool, DS-GPA.•Intracranial tumour volume is a novel independent risk factor for survival.•Incorporating tumour volume with existing prognostic factors improves a valuable pan-cancer prognostic tool.•Performance status remains a simple and robust predictor of survival.