Prognostic indices for brain metastases--usefulness and challenges
Carsten Nieder1, Minesh P Mehta
1Medical Department, Division of Oncology, Nordland Hospital, 8092 Bodø, Norway. cnied@hotmail.com
Radiation Oncology (London, England)
|March 6, 2009
Summary
This review evaluates prognostic indices for cancer patients, comparing them to the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA). Newer indices, like RTOG
Area of Science:
- Oncology
- Biostatistics
- Radiation Therapy
Background:
- Reviews prognostic indices published between 1997-2008, following the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) development.
- Examines prognostic factor analyses in underrepresented patient groups.
- Assesses strengths and weaknesses of six distinct prognostic indices.
Purpose of the Study:
- To compare the methodologies and findings of various prognostic factor analyses.
- To determine if current prognostic indices are sufficiently refined compared to RPA.
- To identify areas for improvement in cancer patient prognostication.
Main Methods:
- Systematic literature search including studies with over 20 patients.
- Extraction and comparison of methods and results from prognostic factor analyses.
- Discussion on the need for refined prognostic indices beyond RPA.
Main Results:
- No index to date incorporates all potential prognostic factors.
- Three recent indices, including RTOG's graded prognostic assessment (GPA), expanded RPA to a 4-tiered system.
- Authors' data support the RTOG GPA and suggest its further evaluation.
Conclusions:
- Current data suggest a need for more refined prognostic indices than RPA.
- Further research should focus on ideal index performance, new parameters, and cancer-type-specific analyses.
- Unusual primary tumors require better representation in pooled analyses.
