Peer-Review ReportValidity of Prognostic Grading Indices for Brain Metastasis Patients Undergoing Repeat Radiosurgery

ObjectivesWe 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).MethodsFor this study, we used our database, which included 804 patients who underwent gamma knife re-SRS during the period 1998-2013.ResultsThere 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.ConclusionsAmong 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.