Identification of prognostic factors in patients with brain metastases: A review of 1292 patients

Purpose: Prognostic factors in 1292 patients with brain metastases; treated in a single institution were identified in order to determine subgroups of patients suitable for selection in future trials. Materials and Methods: From January 1981 through December 1990, 1292 patien ts with CT-diagnosed brain metastases were referred to the Department of Ra diation Oncology, Daniel den Need Cancer Center, Rotterdam. The majority of patients were treated with whole brain radiotherapy (84%), the remainder w ere treated with steroids only or surgery and radiotherapy. Information on potential prognostic factors (age, sex, performance status, number and dist ribution of brain metastases, site of primary tumor, histology, interval be tween primary tumor and brain metastases, systemic tumor activity, serum la ctate dehydrogenase, response to steroid treatment, and treatment modality) was collected. Univariate and multivariate analyses were performed to dete rmine significant prognostic factors. Results were compared with literature findings using a review of prognostic factors in 18 published reports. Results: Overall median survival was 3.4 months, with 6-month, 1-year, and 2-year survival percentages of 36%, 12%, and 4% respectively. Survival was statistically significantly different between treatment modalities, with me dian survival of 1.3 months in patients treated with steroids only, 3.6 mon ths in patients treated with radiotherapy, and 8.9 months in patients treat ed with neurosurgery followed by radiotherapy (p < 0.0001). Multivariate an alysis confirmed literature findings of the major prognostic value of treat ment modality on survival of patients with brain metastases. Performance st atus, response to steroid treatment, systemic tumor activity, and serum lac tate dehydrogenase were independent prognostic factors with the strongest i mpact on survival, second only to treatment modality. Site of primary tumor , age, and number of brain metastases were also identified as prognostic fa ctors in oar material, although with lesser importance. In patients with lu ng primaries, sex was found to have significant impact on survival. In pati ents with breast primaries, interval between primary tumor and development of brain metastases appeared to be a statistically significant prognostic f actor. Histology in patients with lung primaries and distribution of brain metastases were not found to be statistically significant in multivariate a nalysis. Conclusions: In this large database, the value of established prognostic fa ctors was confirmed and, furthermore, some less well-recognized parameters such as response to steroid treatment, serum lactate dehydrogenase, age, se x in lung primaries, and site of primary tumor were established. From the t hree strongest prognostic factors-performance status, response to steroids, and evidence of systemic disease-simple identification of favorable and un favorable subgroups of patients with brain metastases can be constructed. ( C) 1999 Elsevier Science Inc.