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The impact of tumour histology and recursive partitioning analysis classification on the prognosis of patients treated with whole-brain hypofractionated radiotherapy for brain metastases: analysis of 382 patients

Impatto dell’istologia e della classificazione RPA nel predire la prognosi di pazienti affetti da metastasi cerebrali e trattati con radioterapia ipofrazionata sull’encefalo in toto: analisi di 382 pazienti

  • Radiotherapy / Radioterapia
  • Published:
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Abstract

Purpose

Recursive partitioning analysis (RPA) is a prognostic index capable of predicting survival in patients with brain metastases. Histology of the primary tumour has only recently been introduced among the factors that could potentially affect the prognosis of these patients. The main purpose of this study was to analyse the impact of RPA in correlation with histology of the primary tumour in patients with brain metastases treated with hypofractionated radiotherapy.

Materials and methods

A total of 382 patients were treated at the Department of Radiotherapy of Brescia University, and RPA classes were retrospectively assigned to all patients. Univariate and multivariate analyses were then performed to verify the role of the single prognostic variables, for the entire group and for each prognostic class, as well as in correlation with histology of the primary tumour.

Results

Most patients were classified as RPA prognostic class 2 (48%). The majority of patients was treated with a total dose of 30 Gy delivered in ten fractions, whereas the dose of 20 Gy in four or five fractions was primarily used in patients classified as RPA class 3. At univariate analysis, the main variable correlating with overall survival (OS) was RPA class (p=0.000). Uni- and multivariate analysis performed on RPA class 1 patients only confirmed the role of general performance status, number of metastases and total radiotherapy dose for predicting OS. In the group with the worst prognosis (RPA class 3), none of the variables had a statistically significant role in improving OS. Tumour histology and radiotherapy dose influence OS, even in RPA class 1 and 2 patients.

Conclusions

This analysis confirms that RPA prognostic class is the factor that most predicts survival. Primary tumour histology helps determine prognosis, especially in RPA prognostic classes 1 and 2. As regards RPA class 3, no factor influences survival prognosis.

Riassunto

Obiettivo

La recursive partitioning analysis (RPA) è un indice prognostico capace di predire la sopravvivenza in pazienti affetti da metastasi cerebrali. L’istologia della malattia primitiva è stata solo di recente inserita in maniera organica tra i fattori che potenzialmente potrebbero influenzare la prognosi di questi pazienti. L’obiettivo primario di questo studio è quello di analizzare l’impatto della RPA correlato con l’istologia del tumore primitivo in pazienti con metastasi cerebrali, trattati con radioterapia ipofrazionata.

Materiali e metodi

Trecentoottantadue pazienti sono stati trattati presso la Cattedra di Radioterapia di Brescia. La classe RPA è stata attribuita retrospettivamente a tutti i pazienti. È stata quindi eseguita l’analisi univariata e multivariata per verificare il ruolo delle singole variabili prognostiche, nell’intero gruppo e nelle singole classi prognostiche, anche in correlazione con l’istologia del tumore primitivo.

Risultati

La maggior parte dei pazienti è stata classificata nella classe prognostica RPA 2 (48%). La maggior parte dei pazienti è stata trattata con una dose totale di 30 Gy erogati in 10 frazioni, la dose di 20 Gy in 4 o 5 frazioni è stata utilizzata per lo più in pazienti classificati in classe RPA 3. All’analisi univariata la variabile principale correlata alla sopravvivenza globale (OS) è la classe RPA (p=0,000). L’analisi uni- e multivariata eseguita limitatamente ai pazienti in classe prognostica RPA 1 conferma il ruolo del performance status generale, del numero di metastasi e della dose totale di radioterapia nel predire la OS. Nel gruppo prognosticamente peggiore (RPA 3) nessuna variabile ha un ruolo statisticamente significativo nel migliorare la OS. L’istologia della malattia e la dose di radioterapia influiscono sulla OS, anche in pazienti con classi RPA 1 e 2.

Conclusioni

Questa analisi conferma che le classi prognostiche RPA sono il fattore che principalmente influisce sulla sopravvivenza. L’istologia della neoplasia primitiva influisce sulla prognosi specialmente nelle classi prognostiche RPA 1 e 2. Per la classe prognostica RPA 3 nessun fattore influisce sulla sopravvivenza.

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Authors and Affiliations

  1. Radiotherapy Department, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy

    M. Buglione, L. Bandera, N. Pasinetti, P. Borghetti, F. Barbera, L. Triggiani, L. Costa, B. Shehi, B. Bonetti & S. Magrini

  2. Medical Oncology Department, Spedali Civili, Brescia, Italy

    S. Grisanti

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  1. M. Buglione
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  2. L. Bandera
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  3. S. Grisanti
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  4. N. Pasinetti
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  5. P. Borghetti
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Correspondence to M. Buglione.

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Buglione, M., Bandera, L., Grisanti, S. et al. The impact of tumour histology and recursive partitioning analysis classification on the prognosis of patients treated with whole-brain hypofractionated radiotherapy for brain metastases: analysis of 382 patients. Radiol med 117, 133–147 (2012). https://doi.org/10.1007/s11547-011-0738-x

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