Sunday, 22 May 2016

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 alA 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 alPhase 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 alResults 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 alA 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 alA 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 alDiagnosis-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].