Archive | 2021
Validation of the Updated Renal Graded Prognostic Assessment (GPA) for patients with renal cancer brain metastases treated with Gamma Knife radiosurgery
Abstract
\n Introduction: Prognosis of patients with brain metastasis (BM) from renal cell carcinoma (RCC) is relevant for treatment decisions and can be estimated with the Renal Graded Prognostic Assessment (GPA). The aim of this study is to validate the updated version of this instrument in a cohort treated with Gamma Knife radiosurgery (GKRS) without prior local intracerebral therapy. Methods: Between 2007 and 2018, 100 RCC patients with BM were treated with GKRS. They were categorized according to the updated Renal GPA. Overall survival (OS), intracranial disease progression and intracranial local failure were estimated using the Kaplan-Meier method and risk factors were identified with Cox proportional hazard regressions. Results: Median OS was 10.4 months. Median OS for GPA categories 0.0-1.0 (10%), 1.5-2.0 (13%), 2.5-3.0 (37%) and 3.5-4.0 (31%) was 2.9, 5.5, 8.1 and 20.4 months, respectively. Karnofsky performance status <90, serum hemoglobin ≤12.5 g/dL, age >65 years and time from primary diagnosis to brain metastasis <1 year were significantly related with shorter survival, while presence of extracranial disease, the volume and total number of BM had no impact on OS. A total count of >4 BM was the only predictive factor for intracranial disease progression, while none of the investigated factors predicted intracranial local failure. Conclusions: This study confirms the updated Renal GPA in an independent cohort as a valuable instrument to estimate survival in patients with BM from RCC treated with GKRS.