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Long-term Outcome of Gamma Knife Stereotactic Radiosurgery for Multiple Sclerosis Associated Trigeminal Neuralgia
I. J. Radiation Oncology d Biology d Physics
S264
Volume 78, Number 3, Supplement, 2010
Author Disclosure: J. Han, None; B.L. Cahan, None; M.R. Girvigian, None; J.C.T. Chen, None; M.J. Miller, None; K. Lodin, None; A. Arellano, None; J.S. Kaptein, None; J. Rahimian, None.
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Prospective Comparison of the Prognostic Utility of the Montreal Cognitive Assessment and the Mini Mental State Examination in Patients with Brain Metastases
R. A. Olson1,2, H. Carolan1,2, M. Parkinson3, T. Chhanabhai1, M. McKenzie1,2 1
BC Cancer Agency, Vancouver, BC, Canada, 2University of British Columbia, Vancouver, BC, Canada, 3BC Cancer Agency, Surrey, BC, Canada Purpose/Objective(s): In brain metastases patients, the Mini Mental State Examination (MMSE) is the most commonly chosen cognitive screen for both clinical trials and practice, despite its reported poor sensitivity to cognitive impairment, likely because of its prognostic utility. An alternative cognitive screen, the Montreal Cognitive Assessment (MoCA), is more sensitive than the MMSE and better correlated with quality of life. Here, we compare the prognostic utility of the MoCA and MMSE. Materials/Methods: Sixty-nine patients with brain metastases were prospectively accrued to two studies in which subjects completed both the MMSE and MoCA. Overall survival (OS) was analyzed by the Kaplan-Meier method, with the use of two-sided logrank statistics. Multivariate analysis was performed using Cox-proportional hazard models.
Results: The mean age of patients was 58.7 years (SD = 11.3). Lung (42.9%) and breast (14.3%) were the most common sites of primary malignancy. A total of 41.4% of patients had single brain metastases, while 31.4% had three or more metastases. Both the MoCA and MMSE were well tolerated and most often completed within 10 minutes. The mean MMSE and MoCA scores were 27.3 (SD = 3.3) and 22.1 (SD = 5.0) out of 30, respectively. Median OS was significantly worse for individuals with below vs. above average MMSE scores (10.4 vs. 36.3 weeks; p = 0.007). Likewise, below vs. above average MoCA scores were also predictive of median OS (8.3 vs. 53.1 weeks; p \ 0.001). Median OS for MoCA scores 22 or lower, 23 through 26, and 27 or above were 8.3, 30.7, and 61.7 weeks, respectively (p \ 0.001). After controlling for age, gender, primary site, number of metastases, education, and MoCA score, the MMSE was no longer a significant prognostic indicator (HR = 1.91 [0.76, 4.76]; p = 0.165). In contrast, below average MoCA scores were prognostic, even after controlling for age, gender, primary site, number of metastases, education, and MMSE score (HR = 4.39 [2.02, 9.55]; p \ 0.001). Conclusions: Our results indicate that the MoCA is a better prognostic indicator than the MMSE. Furthermore, given its previously reported superior sensitivity to cognitive impairment and better correlation with quality of life and social integration, the MoCA should be preferentially chosen in clinical practice and trials. Author Disclosure: R.A. Olson, None; H. Carolan, None; M. Parkinson, None; T. Chhanabhai, None; M. McKenzie, None.
2133
Predictive Factors in the Obliteration Rate of Arteriovenous Malformations (AVMs) using Linac Based Stereotactic Radiosurgery (SRS)
E. Chung, P. Aditya, J. Balter, J. Hayman, B. G. Thompson, J. Gemmete, C. Tsien University of Michigan, Ann Arbor, MI Purpose/Objective(s): Linac-based SRS is a well-established treatment for AVMs. We performed a retrospective review to determine the obliteration rate, complication rate and the potential dosimetric factors associated with complete obliteration. Materials/Methods: Between 1995 and 2008, 115 patients were treated with single isocentric multi-leaf collimator linac based SRS at the University of Michigan. Patients included in this analysis received treatment to the entire nidus and completed at least 1 year of follow-up imaging. Re-treatments were excluded from this analysis. A total of 86 patients were analyzed. Patients generally completed yearly follow-up MRIs for the initial 2 years and had a confirmatory angiogram the third year post-treatment. Angiograms in patients with incomplete obliteration were reviewed to determine the nidus morphology, number of draining vessels, AVM location, size, and extent/location of nidal reduction. Clinical factors including age, gender, prior treatments, prior history of bleeds, Spetzler Martin Grade (SMG), and radiosurgery-based AVM scores (RBAS) were reviewed. Dosimetric factors including mean dose, minimum dose, homogeneity index, and target volume coverage were reviewed. Results: Median follow-up is 2.9 years. Median age was 38 years (range, 6-75). Median RT dose delivered was 16 Gy (range, 1220 Gy). Median AVM volume was 4.6cc (range, 0.9 to 40.3cc). Fifteen patients received prior surgery or embolization. Obliteration rate for all patients was 66% with a median time to obliteration of 2.4 years. There was a statistically significant correlation between the RBAS groups and obliteration rates (p = 0.035): 80%, 73%, 59%, and 30% for Groups 1, 2, 3, 4, respectively. There was a borderline correlation between RT dose and obliteration rate (p = 0.08), with mean dose of 16.2 Gy in obliterated AVMs vs. 15.6 Gy in non-obliterated AVMs. There was no significant correlation between SMG, deep drainage, prior bleed, prior therapy, and volume of AVM and obliteration rate. There was a significant difference (p = 0.02) in time to obliteration between AVM volumes smaller compared to larger than median (2.2 vs. 2.8 years, respectively). Conclusions: Our results using linac-based SRS demonstrate outcomes comparable to those published in the literature. The only significant factor associated with complete obliteration rate in our dataset was RBAS group. Author Disclosure: E. Chung, None; P. Aditya, None; J. Balter, None; J. Hayman, None; B.G. Thompson, None; J. Gemmete, None; C. Tsien, None.
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Long-term Outcome of Gamma Knife Stereotactic Radiosurgery for Multiple Sclerosis Associated Trigeminal Neuralgia
T. P. Diwanji1, A. A. Dhople1, L. S. Chin2, W. W. Maggio1, J. R. Adams1, W. F. Regine1, Y. Kwok1 1
University of Maryland School of Medicine, Baltimore, MD, 2Boston University School of Medicine, Boston, MA
Proceedings of the 52nd Annual ASTRO Meeting Purpose/Objective(s): Gamma knife radiosurgery (GKS) has been shown to be a viable treatment for Trigeminal Neuralgia (TN) that provides excellent rates of initial pain relief. There are, however, mixed opinions regarding the efficacy of GKS for multiple sclerosis (MS) -associated TN. This is partly because there has not been enough long-term data to support or reject such a hypothesis. The authors report their long-term experience of 13 patients with MS-TN with GKS. Materials/Methods: Thirteen patients (14 nerves, n = 14) with MS-TN were treated with GKS at the University of Maryland between 1998 and 2001. The median dose was 75 Gy (range, 70-80 Gy). The median follow-up was 67 months (range, 13-96 months) after GKS. Results: A BNI score of IV characterized 92.9% of nerves prior to GKS treatment, and the remaining one nerve was described as BNI III. Post GKS BNI scores were as follows, BNI I- 57.1%, BNI III- 7.1%, and BNI IV- 35.7%. An improvement in the BNI score, defined as the initial response rate, was observed in 57.1% of the cases. The median time to pain relief was 1 week (range, 1-9 weeks). Six patients were able to discontinue their TN related medications. Of the patients not experiencing relief from their TN symptoms post GKS, none were able to decrease or discontinue medications. The median duration of relief for patients that responded to the first GKS was 36 months (range, 4-78 months). Actuarial freedom from treatment failure at 1-, 3- and 5-years was 42.9%, 42.9% and 28.6%, respectively. There were no major complications noted among the patients undergoing GKS. Only one of patients (7.1%) experienced new facial numbness that was described as moderately bothersome after GKS. One other patient experienced transient numbness following GKS. Conclusions: This study represents the longest follow-up of any series of MS-TN patients treated with GKS. Our data suggest that GKS remains a satisfactory treatment option because of the relatively favorable toxicity profile in MS patients compared to other treatment modalities. Author Disclosure: T.P. Diwanji, None; A.A. Dhople, None; L.S. Chin, None; W.W. Maggio, None; J.R. Adams, None; W.F. Regine, None; Y. Kwok, None.
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Changes in Prognostic Factors for Glioblastoma Between 1998 and 2006 in the SEER Database
J. C. Flickinger1, L. D. Lunsford2, D. Kondziolka3, F. S. Lieberman4, H. Wagner5, J. McInerney6, J. Sheehan7, J. M. Varlotto5 1 University of Pittsburgh School of Medicine, Department of Radiation Oncology, Pittsburgh, PA, 2University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, PA, 3University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, PA, 4University. of Pittsburgh School of Medicine, Department of Neurology, Pittsburgh Cancer Institute, Pittsburgh, PA, 5Penn State Hershey Cancer Institute, Department of Radiation Oncology, Hershey, PA, 6Penn State Hershey, Department of Neurological Surgery, Pittsburgh, PA, 7Penn State Hershey, Department of Neurological Surgery, Hershey, PA
Purpose/Objective(s): Two recent advances in glioblastoma (GBM) management are the introduction of temozolomide (TMZ) after FDA approvals for recurrent anaplastic astrocytoma in 8/99 and initial GBM therapy in 3/05, as well as improved surgical resection with image-guidance. We accessed the Surveillance, Epidemiology and End Results (SEER) database to assess whether these improvements have changed prognostic features in GBM. Materials/Methods: We identified 8689 adult glioblastoma patients in the SEER database from 1998-2006 representing three eras: 915 between 1/98-7/99 (pre-TMZ), 5849 between 8/99 and 2/05 (off-label TMZ) and 1925 between 9/05-12/06 (TMZ-approved). Results: Overall, 31% had gross total resections, 31 % partial and 38% biopsy/no resection. The percentage of patients reported as undergoing gross total resection increased from 22.0 to 30.2 to 38.8 % over the three eras. Radiotherapy (XRT) was given to 80, 75 and 30 % of those undergoing gross total, partial and no resections.. Multivariate analysis of all 8689 patients correlated survival with age (p = 3.3E-246, hazard rate ratio, HRR = 1.3/decade), XRT (p = 5.3E-190, HRR = 0.45), brainstem, cerebellar or overlapping location (p = 1.2E-7, HRR = 1.2), total resection (p = 1.6E-6, HRR = 0.86), TMZ-approved era (p = 1.2E-5, HRR = .86), married status (p = 5.7E-4, HRR = 0.92), partial resection (p = 1.2E-8, HRR = 1.2) and nonwhite/nonblack race (p = 0.003, HRR = 0.85). Subset multivariate modeling in the in the TMZ-approved era found age, lack of XRT, and partial resection were the only remaining factors associated with poorer survival. The hazard ratio for complete resection decreased from 0.805 to 0.859 to 0.926 for the pre-TMZ, off-label, and TMZ-approved eras. Improved survival with marriage prior to 2005 was predominately seen in men (HRR: 0.87 for men vs. 0.95 for women). Conclusions: Predictors of prognosis have changed in the most recent era in which greater numbers of glioblastoma patients undergo gross total resection and temozolomide chemotherapy. Increasing age and lack of radiotherapy remained the most important factors predicting poor survival in recently treated glioblastoma patients. Author Disclosure: J.C. Flickinger, None; L.D. Lunsford, None; D. Kondziolka, None; F.S. Lieberman, None; H. Wagner, None; J. McInerney, None; J. Sheehan, None; J.M. Varlotto, None.
2136
Impact of Non-small Cell Lung Cancer (NSCLC) Histology on Survival Predicted from the Graded Prognostic Assessment (GPA) for Patients with Brain Metastases
S. Guo, C. A. Reddy, S. T. Chao, J. H. Suh, G. Videtic Cleveland Clinic, Cleveland, OH Purpose/Objective(s): The Graded Prognostic Assessment (GPA) provides a prognostic classification for patients with brain metastases, based on patient and tumor data from the RTOG database of randomized trials. Recent data suggest differential response and outcomes to selected chemotherapy for different NSCLC histologies. Using a large single institutional database of patients with brain metastases, we assessed the impact of histologic subtypes on survival outcomes stratified by the GPA. Materials/Methods: From an IRB-approved database, this retrospective review analyzed 780 patients with NSCLC brain metastases treated from January 1982 to September 2004. GPA classification variables included age, KPS, number of brain metastases, and presence of extracranial disease. Tumor histology was identified for each patient. Median survival time for cohorts based on GPA class and histology were calculated using Kaplan-Meier analysis, and comparisons were made to the published results using results from the GPA. The log-rank test was used to determine statistical differences between survival curves.
S265
S264
Volume 78, Number 3, Supplement, 2010
Author Disclosure: J. Han, None; B.L. Cahan, None; M.R. Girvigian, None; J.C.T. Chen, None; M.J. Miller, None; K. Lodin, None; A. Arellano, None; J.S. Kaptein, None; J. Rahimian, None.
2132
Prospective Comparison of the Prognostic Utility of the Montreal Cognitive Assessment and the Mini Mental State Examination in Patients with Brain Metastases
R. A. Olson1,2, H. Carolan1,2, M. Parkinson3, T. Chhanabhai1, M. McKenzie1,2 1
BC Cancer Agency, Vancouver, BC, Canada, 2University of British Columbia, Vancouver, BC, Canada, 3BC Cancer Agency, Surrey, BC, Canada Purpose/Objective(s): In brain metastases patients, the Mini Mental State Examination (MMSE) is the most commonly chosen cognitive screen for both clinical trials and practice, despite its reported poor sensitivity to cognitive impairment, likely because of its prognostic utility. An alternative cognitive screen, the Montreal Cognitive Assessment (MoCA), is more sensitive than the MMSE and better correlated with quality of life. Here, we compare the prognostic utility of the MoCA and MMSE. Materials/Methods: Sixty-nine patients with brain metastases were prospectively accrued to two studies in which subjects completed both the MMSE and MoCA. Overall survival (OS) was analyzed by the Kaplan-Meier method, with the use of two-sided logrank statistics. Multivariate analysis was performed using Cox-proportional hazard models.
Results: The mean age of patients was 58.7 years (SD = 11.3). Lung (42.9%) and breast (14.3%) were the most common sites of primary malignancy. A total of 41.4% of patients had single brain metastases, while 31.4% had three or more metastases. Both the MoCA and MMSE were well tolerated and most often completed within 10 minutes. The mean MMSE and MoCA scores were 27.3 (SD = 3.3) and 22.1 (SD = 5.0) out of 30, respectively. Median OS was significantly worse for individuals with below vs. above average MMSE scores (10.4 vs. 36.3 weeks; p = 0.007). Likewise, below vs. above average MoCA scores were also predictive of median OS (8.3 vs. 53.1 weeks; p \ 0.001). Median OS for MoCA scores 22 or lower, 23 through 26, and 27 or above were 8.3, 30.7, and 61.7 weeks, respectively (p \ 0.001). After controlling for age, gender, primary site, number of metastases, education, and MoCA score, the MMSE was no longer a significant prognostic indicator (HR = 1.91 [0.76, 4.76]; p = 0.165). In contrast, below average MoCA scores were prognostic, even after controlling for age, gender, primary site, number of metastases, education, and MMSE score (HR = 4.39 [2.02, 9.55]; p \ 0.001). Conclusions: Our results indicate that the MoCA is a better prognostic indicator than the MMSE. Furthermore, given its previously reported superior sensitivity to cognitive impairment and better correlation with quality of life and social integration, the MoCA should be preferentially chosen in clinical practice and trials. Author Disclosure: R.A. Olson, None; H. Carolan, None; M. Parkinson, None; T. Chhanabhai, None; M. McKenzie, None.
2133
Predictive Factors in the Obliteration Rate of Arteriovenous Malformations (AVMs) using Linac Based Stereotactic Radiosurgery (SRS)
E. Chung, P. Aditya, J. Balter, J. Hayman, B. G. Thompson, J. Gemmete, C. Tsien University of Michigan, Ann Arbor, MI Purpose/Objective(s): Linac-based SRS is a well-established treatment for AVMs. We performed a retrospective review to determine the obliteration rate, complication rate and the potential dosimetric factors associated with complete obliteration. Materials/Methods: Between 1995 and 2008, 115 patients were treated with single isocentric multi-leaf collimator linac based SRS at the University of Michigan. Patients included in this analysis received treatment to the entire nidus and completed at least 1 year of follow-up imaging. Re-treatments were excluded from this analysis. A total of 86 patients were analyzed. Patients generally completed yearly follow-up MRIs for the initial 2 years and had a confirmatory angiogram the third year post-treatment. Angiograms in patients with incomplete obliteration were reviewed to determine the nidus morphology, number of draining vessels, AVM location, size, and extent/location of nidal reduction. Clinical factors including age, gender, prior treatments, prior history of bleeds, Spetzler Martin Grade (SMG), and radiosurgery-based AVM scores (RBAS) were reviewed. Dosimetric factors including mean dose, minimum dose, homogeneity index, and target volume coverage were reviewed. Results: Median follow-up is 2.9 years. Median age was 38 years (range, 6-75). Median RT dose delivered was 16 Gy (range, 1220 Gy). Median AVM volume was 4.6cc (range, 0.9 to 40.3cc). Fifteen patients received prior surgery or embolization. Obliteration rate for all patients was 66% with a median time to obliteration of 2.4 years. There was a statistically significant correlation between the RBAS groups and obliteration rates (p = 0.035): 80%, 73%, 59%, and 30% for Groups 1, 2, 3, 4, respectively. There was a borderline correlation between RT dose and obliteration rate (p = 0.08), with mean dose of 16.2 Gy in obliterated AVMs vs. 15.6 Gy in non-obliterated AVMs. There was no significant correlation between SMG, deep drainage, prior bleed, prior therapy, and volume of AVM and obliteration rate. There was a significant difference (p = 0.02) in time to obliteration between AVM volumes smaller compared to larger than median (2.2 vs. 2.8 years, respectively). Conclusions: Our results using linac-based SRS demonstrate outcomes comparable to those published in the literature. The only significant factor associated with complete obliteration rate in our dataset was RBAS group. Author Disclosure: E. Chung, None; P. Aditya, None; J. Balter, None; J. Hayman, None; B.G. Thompson, None; J. Gemmete, None; C. Tsien, None.
2134
Long-term Outcome of Gamma Knife Stereotactic Radiosurgery for Multiple Sclerosis Associated Trigeminal Neuralgia
T. P. Diwanji1, A. A. Dhople1, L. S. Chin2, W. W. Maggio1, J. R. Adams1, W. F. Regine1, Y. Kwok1 1
University of Maryland School of Medicine, Baltimore, MD, 2Boston University School of Medicine, Boston, MA
Proceedings of the 52nd Annual ASTRO Meeting Purpose/Objective(s): Gamma knife radiosurgery (GKS) has been shown to be a viable treatment for Trigeminal Neuralgia (TN) that provides excellent rates of initial pain relief. There are, however, mixed opinions regarding the efficacy of GKS for multiple sclerosis (MS) -associated TN. This is partly because there has not been enough long-term data to support or reject such a hypothesis. The authors report their long-term experience of 13 patients with MS-TN with GKS. Materials/Methods: Thirteen patients (14 nerves, n = 14) with MS-TN were treated with GKS at the University of Maryland between 1998 and 2001. The median dose was 75 Gy (range, 70-80 Gy). The median follow-up was 67 months (range, 13-96 months) after GKS. Results: A BNI score of IV characterized 92.9% of nerves prior to GKS treatment, and the remaining one nerve was described as BNI III. Post GKS BNI scores were as follows, BNI I- 57.1%, BNI III- 7.1%, and BNI IV- 35.7%. An improvement in the BNI score, defined as the initial response rate, was observed in 57.1% of the cases. The median time to pain relief was 1 week (range, 1-9 weeks). Six patients were able to discontinue their TN related medications. Of the patients not experiencing relief from their TN symptoms post GKS, none were able to decrease or discontinue medications. The median duration of relief for patients that responded to the first GKS was 36 months (range, 4-78 months). Actuarial freedom from treatment failure at 1-, 3- and 5-years was 42.9%, 42.9% and 28.6%, respectively. There were no major complications noted among the patients undergoing GKS. Only one of patients (7.1%) experienced new facial numbness that was described as moderately bothersome after GKS. One other patient experienced transient numbness following GKS. Conclusions: This study represents the longest follow-up of any series of MS-TN patients treated with GKS. Our data suggest that GKS remains a satisfactory treatment option because of the relatively favorable toxicity profile in MS patients compared to other treatment modalities. Author Disclosure: T.P. Diwanji, None; A.A. Dhople, None; L.S. Chin, None; W.W. Maggio, None; J.R. Adams, None; W.F. Regine, None; Y. Kwok, None.
2135
Changes in Prognostic Factors for Glioblastoma Between 1998 and 2006 in the SEER Database
J. C. Flickinger1, L. D. Lunsford2, D. Kondziolka3, F. S. Lieberman4, H. Wagner5, J. McInerney6, J. Sheehan7, J. M. Varlotto5 1 University of Pittsburgh School of Medicine, Department of Radiation Oncology, Pittsburgh, PA, 2University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, PA, 3University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, PA, 4University. of Pittsburgh School of Medicine, Department of Neurology, Pittsburgh Cancer Institute, Pittsburgh, PA, 5Penn State Hershey Cancer Institute, Department of Radiation Oncology, Hershey, PA, 6Penn State Hershey, Department of Neurological Surgery, Pittsburgh, PA, 7Penn State Hershey, Department of Neurological Surgery, Hershey, PA
Purpose/Objective(s): Two recent advances in glioblastoma (GBM) management are the introduction of temozolomide (TMZ) after FDA approvals for recurrent anaplastic astrocytoma in 8/99 and initial GBM therapy in 3/05, as well as improved surgical resection with image-guidance. We accessed the Surveillance, Epidemiology and End Results (SEER) database to assess whether these improvements have changed prognostic features in GBM. Materials/Methods: We identified 8689 adult glioblastoma patients in the SEER database from 1998-2006 representing three eras: 915 between 1/98-7/99 (pre-TMZ), 5849 between 8/99 and 2/05 (off-label TMZ) and 1925 between 9/05-12/06 (TMZ-approved). Results: Overall, 31% had gross total resections, 31 % partial and 38% biopsy/no resection. The percentage of patients reported as undergoing gross total resection increased from 22.0 to 30.2 to 38.8 % over the three eras. Radiotherapy (XRT) was given to 80, 75 and 30 % of those undergoing gross total, partial and no resections.. Multivariate analysis of all 8689 patients correlated survival with age (p = 3.3E-246, hazard rate ratio, HRR = 1.3/decade), XRT (p = 5.3E-190, HRR = 0.45), brainstem, cerebellar or overlapping location (p = 1.2E-7, HRR = 1.2), total resection (p = 1.6E-6, HRR = 0.86), TMZ-approved era (p = 1.2E-5, HRR = .86), married status (p = 5.7E-4, HRR = 0.92), partial resection (p = 1.2E-8, HRR = 1.2) and nonwhite/nonblack race (p = 0.003, HRR = 0.85). Subset multivariate modeling in the in the TMZ-approved era found age, lack of XRT, and partial resection were the only remaining factors associated with poorer survival. The hazard ratio for complete resection decreased from 0.805 to 0.859 to 0.926 for the pre-TMZ, off-label, and TMZ-approved eras. Improved survival with marriage prior to 2005 was predominately seen in men (HRR: 0.87 for men vs. 0.95 for women). Conclusions: Predictors of prognosis have changed in the most recent era in which greater numbers of glioblastoma patients undergo gross total resection and temozolomide chemotherapy. Increasing age and lack of radiotherapy remained the most important factors predicting poor survival in recently treated glioblastoma patients. Author Disclosure: J.C. Flickinger, None; L.D. Lunsford, None; D. Kondziolka, None; F.S. Lieberman, None; H. Wagner, None; J. McInerney, None; J. Sheehan, None; J.M. Varlotto, None.
2136
Impact of Non-small Cell Lung Cancer (NSCLC) Histology on Survival Predicted from the Graded Prognostic Assessment (GPA) for Patients with Brain Metastases
S. Guo, C. A. Reddy, S. T. Chao, J. H. Suh, G. Videtic Cleveland Clinic, Cleveland, OH Purpose/Objective(s): The Graded Prognostic Assessment (GPA) provides a prognostic classification for patients with brain metastases, based on patient and tumor data from the RTOG database of randomized trials. Recent data suggest differential response and outcomes to selected chemotherapy for different NSCLC histologies. Using a large single institutional database of patients with brain metastases, we assessed the impact of histologic subtypes on survival outcomes stratified by the GPA. Materials/Methods: From an IRB-approved database, this retrospective review analyzed 780 patients with NSCLC brain metastases treated from January 1982 to September 2004. GPA classification variables included age, KPS, number of brain metastases, and presence of extracranial disease. Tumor histology was identified for each patient. Median survival time for cohorts based on GPA class and histology were calculated using Kaplan-Meier analysis, and comparisons were made to the published results using results from the GPA. The log-rank test was used to determine statistical differences between survival curves.
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