Subclassification of Recursive Partitioning Analysis Class II Patients With Brain Metastases Treated Radiosurgically

详细信息    查看全文

• 作者：Masaaki Yamamoto ; Yasunori Sato ; Toru Serizawa ; Takuya Kawabe ; Yoshinori Higuchi ; Osamu Nagano ; Bierta E. Barfod ; Junichi Ono ; Hidetoshi Kasuya ; Yoichi Urakawa
• 关键词：Brain metastases ; Prognosis ; Grading system ; Radiation therapy ; Radiosurgery ; Gamma Knife
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 出版时间：1 August, 2012
• 年：2012
• 卷：83
• 期：5
• 页码：1399-1405
• 全文大小：419 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Purpose

Although the recursive partitioning analysis (RPA) class is generally used for predicting survival periods of patients with brain metastases (METs), the majority of such patients are Class II and clinical factors vary quite widely within this category. This prompted us to divide RPA Class II patients into three subclasses.

Methods and Materials

This was a two-institution, institutional review board-approved, retrospective cohort study using two databases: the Mito series (2,000 consecutive patients, comprising 787 women and 1,213 men; mean age, 65 years [range, 19-96 years]) and the Chiba series (1,753 patients, comprising 673 female and 1,080 male patients; mean age, 65 years [range, 7-94 years]). Both patient series underwent Gamma Knife radiosurgery alone, without whole-brain radiotherapy, for brain METs during the same 10-year period, July 1998 through June 2008. The Cox proportional hazard model with a step-wise selection procedure was used for multivariate analysis.

Results

In the Mito series, four factors were identified as favoring longer survival: Karnofsky Performance Status (90 % to 100 % vs. 70 % to 80 % ), tumor numbers (solitary vs. multiple), primary tumor status (controlled vs. not controlled), and non-brain METs (no vs. yes). This new index is the sum of scores (0 and 1) of these four factors: RPA Class II-a, score of 0 or 1; RPA Class II-b, score of 2; and RPA Class II-c, score of 3 or 4. Next, using the Chiba series, we tested whether our index is valid for a different patient group. This new system showed highly statistically significant differences among subclasses in both the Mito series and the Chiba series (p < 0.001 for all subclasses). In addition, this new index was confirmed to be applicable to Class II patients with four major primary tumor sites, that is, lung, breast, alimentary tract, and urogenital organs.

Conclusions

Our new grading system should be considered when designing future clinical trials involving brain MET patients.