Usage:
All variables for calculating the GPA should be entered based on
first diagnosis of brain metastasis(es). A GPA of 4 and 0 are
associated with best and worst prognosis respectively.
About the tool
The prognosis of patients with brain metastases varies widely according to
tumour subtype, clinical parameters and molecular features. The GPA was developed as a
tool to estimate prognosis in patients with brain metastases, to guide clinical decision
making and potential clinical trial suitability.
The GPA was first published in 2008 based on 1960 patients from 5 randomised
trials (RTOG 7916, RTOG 8528, RTOG 8905, RTOG 9104, RTOG 9508) (1). Four variables:
age, Karnofsky Performance Status (KPS), extracranial metastases and number of brain
metastases were found to be significantly associated with survival. The tool was further
developed in 2012, based on a retrospective analysis of 3940 patients which stratified
prognosis according to tumour subtype and subtype specific prognostic factors (2,3).
The tool was further updated in 2020 based on 6984 patients with newly diagnosed brain
metastases (4). The lung cancer component of the score was updated in 2022 based on 4183
patients with primary lung cancer and newly diagnosed brain metastases, including for the
first-time patients with small cell lung cancer (5). The authors of the tool also created
an online tool to calculate GPA (6).
References:
Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. 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;70(2):510-514. doi:10.1016/j.ijrobp.2007.06.074
Sperduto PW, Kased N, Roberge D, et al. Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys. 2012;82(5):2111-2117. doi:10.1016/j.ijrobp.2011.02.027
Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(4):419-425. doi:10.1200/JCO.2011.38.0527
Sperduto PW, Mesko S, Li J, et al. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. J Clin Oncol Off J Am Soc Clin Oncol. 2020;38(32):3773-3784. doi:10.1200/JCO.20.01255
Sperduto PW, De B, Li J, et al. Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors. Int J Radiat Oncol Biol Phys. 2022;114(1):60-74. doi:10.1016/j.ijrobp.2022.03.020
