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Validation of the updated renal graded prognostic assessment (GPA) for patients with renal cancer brain metastases treated with gamma knife radiosurgery

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Abstract

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, 106 RCC patients with BM were treated with GKRS. They were categorized according to the updated Renal GPA. Overall survival (OS), distant intracranial failure and local failure were estimated using the Kaplan–Meier method and risk factors were identified with Cox proportional hazard regressions.

Results

Median OS was 8.6 months. Median OS for GPA categories 0.0–1.0 (15%), 1.5–2.0 (12%), 2.5–3.0 (35%) and 3.5–4.0 (29%) 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 significant impact on OS. A total count of > 4 BM was the only predictive factor for distant intracranial failure, while none of the investigated factors predicted 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.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors received no specific funding for this work.

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Author notes

  1. Laurens V. Beerepoot and Patrick E. J. Hanssens have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine/Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands

    Niels J. van Ruitenbeek & Laurens V. Beerepoot

  2. Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Vincent K. Y. Ho

  3. Department of Internal Medicine/Oncology, Amphia Hospital, Breda, The Netherlands

    Hans M. Westgeest

  4. Gamma Knife Center Tilburg, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands

    Patrick E. J. Hanssens

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  1. Niels J. van Ruitenbeek
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  4. Laurens V. Beerepoot
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Contributions

Conception and design: NR, VH, LB, PH. Data collection and assembly: NR. Data analysis and interpretation: all authors. Writing the original draft: NR. Reviewing and editing: all authors. Supervision: LB, PH.

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Correspondence to Niels J. van Ruitenbeek.

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van Ruitenbeek, N.J., Ho, V.K.Y., Westgeest, H.M. et al. Validation of the updated renal graded prognostic assessment (GPA) for patients with renal cancer brain metastases treated with gamma knife radiosurgery. J Neurooncol 153, 527–536 (2021). https://doi.org/10.1007/s11060-021-03793-9

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  • DOI: https://doi.org/10.1007/s11060-021-03793-9

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