PROGNOSTIC FACTORS DERIVED FROM RECURSIVE PARTITION ANALYSIS (RPA) OFRADIATION-THERAPY ONCOLOGY GROUP (RTOG) BRAIN METASTASES TRIALS APPLIED TO SURGICALLY RESECTED AND IRRADIATED BRAIN METASTATIC CASES

Purpose: (a) To identify the prognostic factors that determine surviva l after surgical resection and irradiation of tumors metastatic to bra in. (b) To determine if the prognostic factors used in the recursive p artition analysis (RPA) of brain metastases cases from Radiation Thera py Oncology Group (RTOG) studies into three distinct survival classes is applicable to surgically resected and irradiated patients. Method: The medical records of 125 patients who had surgical resection and rad iotherapy for brain metastases from 1985 to 1997 were reviewed. The pa tients' disease and treatment related factors were analyzed to identif y factors that independently determine survival after diagnosis of bra in metastasis. The patients were also grouped into three classes using the RPA-derived prognostic parameters which are: age, performance sta tus, state of the primary disease, and presence or absence of extracra nial metastases. Class 1: patients less than or equal to 65 years of a ge, Karnofsky performance status (KPS) of greater than or equal to 70, with controlled primary disease and no extracranial metastases; Class 3: patients with KPS < 70. Patients who do not qualify for Class I or 3 are grouped as Class 2. The survival of these patients was determin ed from the time of diagnosis of brain metastases to the time of death . Results: The median survival of the entire group was 9.5 months. The three classes of patients as grouped had median survivals of 14.8, 9. 9, and 6.0 months respectively (p = 0.0002). Age of < 65 years, KPS of greater than or equal to 70, controlled primary disease, absence of e xtracranial metastases, complete surgical resection of the brain lesio n(s) were found to be independent prognostic factors for survival; the total dose of radiation was not. Conclusion: Based on the results of this study, the patients and disease characteristics have significant impact on the survival of patients with brain metastases treated with a combination of surgical resection and radiotherapy. These parameters could be used in selecting patients who would benefit most from such treatment. (C) 1998 Elsevier Science Inc.