Prognostic Classification Systems for Brain Metastases
Patients with brain metastases are a heterogeneous population. The epidemiology of brain metastases is addressed elsewhere in this textbook. In the past, outcomes were considered uniformly grim for all patients with brain metastases. We now know that outcomes vary widely by diagnosis (type of primary cancer) and diagnosis-specific prognostic factors. This chapter reviews the history of prognostic classifications for patients with brain metastases and the current state of knowledge in this area. Such classification systems are important for two reasons: (1) they facilitate clinical decision-making regarding whether and what treatment is appropriate, and (2) they provide a method for stratification of clinical trials to ensure trials are comparing comparable patients, which is particularly important in such a heterogeneous patient population.
KeywordsBrain metastases Outcomes Prognosis
This work has been a collaborative multi-institutional effort. The faculty and residents of the following institutions have selflessly contributed time and energy to one or more of the studies on the Graded Prognostic Assessment: MD Anderson; Memorial Sloan Kettering Cancer Center; Mayo Clinic; University of California, San Francisco; Massachusetts General Hospital; Dana-Farber Cancer Institute; Duke University; Yale University; University of Colorado Denver; Cleveland Clinic; University of Wisconsin-Madison; McGill University; Centre Hospitalier de l’ Université de Montreal; University of Maryland; University of Alabama at Birmingham; and the University of Minnesota. This work would not have been possible without the tireless work of these dedicated colleagues. Special recognition is appropriate for Ryan Shanley who has provided his statistical wisdom for nearly a decade.
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