• Paul W Sperduto, Penny Fang, Jing Li, William Breen, Paul D Brown, Daniel Cagney, Ayal Aizer, James Yu, Veronica Chiang, Supriya Jain, Laurie E Gaspar, Sten Myrehaug, Arjun Sahgal, Steve Braunstein, Penny Sneed, Brent Cameron, Albert Attia, Jason Molitoris, Cheng-Chia Wu, WangTony J CTJCColumbia University Medical Center., Natalie Lockney, Kathryn Beal, Jessica Parkhurst, John M Buatti, Ryan Shanley, Emil Lou, Daniel D Tandberg, John P Kirkpatrick, Diana Shi, Helen A Shih, Michael Chuong, Hirotake Saito, Hidefumi Aoyama, Laura Masucci, David Roberge, and Minesh P Mehta.
• Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center. Electronic address: psperduto@mropa.com.
• Transl Res. 2019 Jun 1; 208: 63-72.

AbstractThe literature describing the prognosis of patients with gastrointestinal (GI) cancers and brain metastases (BM) is sparse. Our group previously published a prognostic index, the Graded Prognostic Assessment (GPA) for GI cancer patients with BM, based on 209 patients diagnosed from 1985-2005. The purpose of this analysis is to identify prognostic factors for GI cancer patients with newly diagnosed BM in a larger contemporary cohort. A multi-institutional retrospective IRB-approved database of 792 GI cancer patients with new BM diagnosed from 1/1/2006 to 12/31/2016 was created. Demographic data, clinical parameters, and treatment were correlated with survival and time from primary diagnosis to BM (TPDBM). Kaplan-Meier median survival (MS) estimates were calculated and compared with log-rank tests. The MS from time of first treatment for BM for the prior and current cohorts were 5 and 8 months, respectively (P < 0.001). Eight prognostic factors (age, stage, primary site, resection of primary tumor, Karnofsky Performance Status (KPS), extracranial metastases, number of BM and Hgb were found to be significant for survival, in contrast to only one (KPS) in the prior cohort. In this cohort, the most common primary sites were rectum (24%) and esophagus (23%). Median TPDBM was 22 months. Notably, 37% (267/716) presented with poor prognosis (GPA 0-1.0). Although little improvement in overall survival in this cohort has been achieved in recent decades, survival varies widely and multiple new prognostic factors were identified. Future work will translate these factors into a prognostic index to facilitate clinical decision-making and stratification of future clinical trials.Copyright © 2019 Elsevier Inc. All rights reserved.

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