GPA (Graded Prognostic Assessment)

It is a prognostic index for patients with brain metastases. It was originally developed from a database of patients accrued to four Radiation Therapy Oncology Group (RTOG) protocols [1-4] for patients with brain metastases. It was validate twice by Sperduto et al. [5,6]:

GPA Criteria For Brain Metastases
Variable	0 Points	0.5 Points	1 Point
Age (years)	>60	50-59	<50
KPS	<70	70-80	90-100
No. of CNS metastases	>3	2-3	1
Extracranial metastases	Present	-	Absent

CNS = central nervous system; KPS = Karnofsky performance status.

Source: [5].

GPA Survival
GPA Score	Median OS
0-1	2.6 months
1.5-2.5	3.8 months
3.0	6.9 months
3.5-4.0	11.0 months

OS: overall survival.

Source: [7].

GPA Criteria For Brain Metastases
Variable	0 Points	0.5 Points	1 Point	2 Points	3 Points	4 Points
NSCLC/SCLC
Age	>60	50-59	<50	-	-	-
KPS	<70	70-80	90-100	-	-	-
No. of cranial metastasis	>3	2-3	1	-	-	-
Extracranial metastases	Present	-	Absent	-	-	-
Renal/Melanoma
KPS	<70	-	70-80	90-100	-	-
No. of cranial metastases	>3	-	2-3	1	-	-
Breast/GI
KPS	<70	-	70	80	90	100

CNS = central nervous system; GI = gastrointestinal; KPS = Karnofsky performance status; NSCLC = non–small-cell lung cancer; SCLC = small-cell lung cancer.
Source: [6,7].

Median OS Survival (months)
GPA Score	NSCLC	SCLC	Melanoma	Renal cell	Breast	GI
0-1	3.0	2.8	3.4	3.3	6.1	3.1
1.5-2.5	6.5	5.3	4.7	7.3	9.4	4.4
3.0	11.3	9.6	8.8	11.3	16.9	6.9
3.5-4.0	14.8	17.0	13.2	14.8	18.7	13.5
Overall	7.0	4.9	6.7	9.6	11.9	5.4

GI = gastrointestinal; NSCLC = non–small-cell lung cancer; OS: overall survival; SCLC = small-cell lung cancer.
Source: [7].

GPA is now used to stratify clinical trials [8].

Bibliographic references:

[1] Komarnicky LT, Phillips TL, Martz K, et al. A randomized phase III protocol for the evaluation of misonidazole combined with radiation in the treatment of patients with brain metastases (RTOG-7916). Int J Radiat Oncol Biol Phys. 1991 Jan;20(1):53-8. Available at: http://dx.doi.org/10.1016/0360-3016(91)90137-s.

[2] Sause WT, Scott C, Krisch R, et al. Phase I/II trial of accelerated fractionation in brain metastases RTOG 85-28. Int J Radiat Oncol Biol Phys. 1993 Jul 15;26(4):653-7. Available at: http://dx.doi.org/10.1016/0360-3016(93)90284-3.

[3] Phillips TL, Scott CB, Leibel SA, et al. Results of a randomized comparison of radiotherapy and bromodeoxyuridine with radiotherapy alone for brain metastases: report of RTOG trial 89-05. Int J Radiat Oncol Biol Phys. 1995 Sep 30;33(2):339-48. Available at: http://dx.doi.org/10.1016/0360-3016(95)00168-x.

[4] Murray KJ, Scott C, Greenberg HM, et al. A randomized phase III study of accelerated hyperfractionation versus standard in patients with unresected brain metastases: a report of the Radiation Therapy Oncology Group (RTOG) 9104. Int J Radiat Oncol Biol Phys. 1997 Oct 1;39(3):571-4. Available at: http://dx.doi.org/10.1016/s0360-3016(97)00341-6.

[5] Sperduto PW, Berkey B, Gaspar LE, et al. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):510-4. Available at: http://dx.doi.org/10.1016/j.ijrobp.2007.06.074.

[6] Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):655-61. Available at: http://dx.doi.org/10.1016/j.ijrobp.2009.08.025.

[7] En.wikibooks.org. (2013). Radiation Oncology/Palliation/Brain Metastases/Overview - Wikibooks, open books for an open world. [online] Available at: https://en.wikibooks.org/wiki/Radiation_Oncology/Palliation/Brain_Metastases/Overview#Graded_Prognostic_Assessment_.28GPA.29 [Accessed 22 May 2016].

[8] Brainmetgpa.com. (n.d.). GPA Index. [online] Available at: http://brainmetgpa.com/ [Accessed 22 May 2016].