Prognostic Factors of D'Ambrosio and Agazzi for a Patient with a Brain Metastasis from an Unknown Primary

 

Patient selection: presentation with brain metastasis AND primary tumor previously undiagnosed

 

Parameters:

(1) age of the patient

(2) therapy for the brain metastasis

(3) status

(4) systemic metastases

(5) symptoms associated with the cerebral metastasis

 

Parameter	Finding	Points
age of the patient	< 65 years of age	0
	>= 65 years of age	1
therapy for brain metastasis	surgery with whole brain radiation therapy	0
	other	1
status	discharged home (but not hospice)	0
	not discharged home	1
systemic metastases	absent	0
	present	1
symptoms from CNS metastasis	absent	0
	present	1

 

where:

• If and how to treat a patient with a brain metastasis is usually influenced by the expectation for survival.

• Complete resection with radiation therapy should have a better survival than incomplete resection.

• A patient who was not considered a surgical candidate might undergo radiation therapy and/or corticosteroid therapy as palliative measures.

• Clinical symptoms may include a focal deficit, seizure, intracranial hypertension, and/or headache.

 

number of risk factors =

= SUM(points for the 5 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 5

• The lower the number of risk factors the better the prognosis. Unfortunately a better prognosis is usually not very good.

• There was no benefit to find the primary tumor before addressing the brain lesion. It was better to treat the brain tumor first rather than spending time looking for the primary.