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

Frank J. Lagerwaard . IJROBP 1999;43:795

From January 1981 through December 1990, 1292 patients with CT-diagnosed brain metastases were referred to the Department of Radiation Oncology, Daniel den Hoed Cancer Center, Rotterdam. The majority of patients were treated with whole brain radiotherapy (84%), the remainder were treated with steroids only or surgery and radiotherapy.

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 median survival of 1.3 months in patients treated with steroids only, 3.6 months in patients treated with radiotherapy, and 8.9 months in patients treated with neurosurgery followed by radiotherapy

Within the subgroup of patients treated with radiotherapy only, three prognostic subgroups could be constructed:

“good prognosis”: ECOG 0 or 1 and no or limited systemic tumor activity and good response to steroids

“poor prognosis”: ECOG 2 or 3 and systemic tumor activity limited or extensive and little response to steroids

“moderate prognosis”: all other patients treated with radiotherapy.

 

Survival curves for the prognostic groups are shown. The median survival for these groups are 6.3 months (“good prognosis,, 3.4 months (“moderate prognosis"), and 1.3 months (“poor prognosis,”