Sperduto et al developed the Graded Prognostic Assessment (GPA) to evaluate patients with brain metastases. The authors are from the University of Minnesota and Ridgeview Medical Center in Minnesota.
Patient selection: The original GPA was used on all patients with brain metastases. Later the GPA was modified for primary site, and this original form was designated for lung cancer patients (non-small cell and small cell).
Parameters:
(1) age of the patient in years
(2) Karnofsky Performance Scale (KPS)
(3) number of metastases to the central nervous system (CNS)
(4) extracranial metastases
Parameter
Finding
Points
age of the patient
< 50 years
1
50 to 59
0.5
>= 60
0
KPS
90 or 100
1
70 or 80
0.5
<= 60
0
number of CNS metastases
1
1
2 or 3
0.5
4 or more
0
extracranial metastases
none
1
present
0
total GPA =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score 4
• The higher the GPA the better the prognosis.
GPA
Median Survival Time (MST)
Median Survival for Lung Cancer
0, 0.5, 1.0
2.6 to 3.0 months
3.0 months
1.5, 2.0 or 2.5
3.8 to 5.9 months
5.5 months
3.0
8.9 to 17.5 months
9.4 months
3.5 or 4.0
11 to 21.7 months
14.8 months
where:
• The survival time for a GPA 3.0 overlaps that of 3.5 and 4.0.
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