Prognostic Index of Sundaresan et al for Identifying a Lung Cancer Patient with Multiple Brain Metastases Who May Have an Early Death and Not Benefit from Whole Brain Radiotherapy
Sundaresan et al reported a prognostic index for lung cancer patients with multiple brain metastases. This can help to identify a patient who may not benefit from whole brain radiation therapy. The authors are from Westmead Hospital and the University of Sydney in Australia.
Patient selection: lung cancer with multiple brain metastases
Therapy: whole brain radiation therapy (WBRT). After therapy it takes 6 weeks for there to be a benefit. Anyone who is likely to die within 6 weeks is unlikely to benefit.
Parameters:
(1) age of the patient in years
(2) ECOG performance status
(3) weight loss in percent
(4) type of lung cancer
(5) primary under control
(6) metastases to bone
(7) metastases to viscera
Parameter
Finding
Points
age of the patient
<= 65 years
0
> 65 years
3
ECOG
0 to 2
0
3 or 4
20
weight loss
<= 10%
0
> 10%
3
type of cancer
small cell
0
non-small cell (NSCLC)
2
primary under control
yes
0
no
5
metastases
bone
3
viscera
3
both
4
none of these
0
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 37
• A score >= 13 was associated with odds ratio 8.6 for early death (within 6 weeks).
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