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
|
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
|
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
|
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].
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