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Radiation Oncology
Published in: Radiation Oncology 1/2009

Open Access 01-12-2009 | Review

Prognostic indices for brain metastases – usefulness and challenges

Authors: Carsten Nieder, Minesh P Mehta

Published in: Radiation Oncology | Issue 1/2009

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Abstract

Background

This review addresses the strengths and weaknesses of 6 different prognostic indices, published since the Radiation Therapy Oncology Group (RTOG) developed and validated the widely used 3-tiered prognostic index known as recursive partitioning analysis (RPA) classes, i.e. between 1997 and 2008. In addition, other analyses of prognostic factors in groups of patients, which typically are underrepresented in large trials or databases, published in the same time period are reviewed.

Methods

Based on a systematic literature search, studies with more than 20 patients were included. The methods and results of prognostic factor analyses were extracted and compared. The authors discuss why current data suggest a need for a more refined index than RPA.

Results

So far, none of the indices has been derived from analyses of all potential prognostic factors. The 3 most recently published indices, including the RTOG's graded prognostic assessment (GPA), all expanded from the primary 3-tiered RPA system to a 4-tiered system. The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool.

Conclusion

This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types. Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.
Appendix
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Metadata
Title
Prognostic indices for brain metastases – usefulness and challenges
Authors
Carsten Nieder
Minesh P Mehta
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2009
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-4-10

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