Validity of prognostic grading indices for brain metastasis patients undergoing repeat radiosurgery

Masaaki Yamamoto, Takuya Kawabe, Yoshinori Higuchi, Yasunori Sato, Tadashi Nariai, Shinya Watanabe, Bierta E. Barfod, Hidetoshi Kasuya

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)


Objectives We tested the validity of 5 prognostic indices, Recursive Partitioning Analysis (RPA), Score Index for Radiosurgery (SIR), Basic Score for Brain Metastases (BSBM), Graded Prognostic Assessment (GPA), and Modified-RPA, for patients who underwent repeat stereotactic radiosurgery (re-SRS).

Methods For this study, we used our database, which included 804 patients who underwent gamma knife re-SRS during the period 1998-2013.

Conclusions Among the 5 systems, based on patient number proportions, MST separation among the 3/4 groups, and/or detailed reflection of status changes, the Modified-RPA system was shown to be most applicable to re-SRS patients.

Results There were statistically significant survival differences among patients stratified into 3 or 4 groups based on the 5 systems (P < 0.001). With RPA, SIR, BSBM, and the Modified-RPA, there were statistically significant median survival time (MST) differences between any 2 pairs within the 3/4 groups. With the GPA system, however, the MST difference between the GPA 3.5-4.0 and GPA 3.0 groups did not reach statistical significance (P = 0.48). There were large patient number discrepancies among the 3/4 groups in the RPA, SIR, BSBM, and GPA whereas patient numbers were very similar among the 3 Modified-RPA system groups. Our present results show the RPA and BSBM systems to reflect changes less well, with 86%-95% of patients remaining in the same categories between the first and second SRS procedures. However, with SIR, GPA, and the Modified-RPA, 25%-31% of patients were categorized into different subclasses, either better or worse. With the modified-RPA system, such categorical change correlated well with post-re-SRS MSTs.

Original languageEnglish
Pages (from-to)1242-1249
Number of pages8
JournalWorld neurosurgery
Issue number6
Publication statusPublished - 2014 Dec 1
Externally publishedYes


  • Brain metastases
  • Prognostic index
  • Radiosurgery
  • Recurrence

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


Dive into the research topics of 'Validity of prognostic grading indices for brain metastasis patients undergoing repeat radiosurgery'. Together they form a unique fingerprint.

Cite this