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Ribeiro LM, Bomtempo FF, Rocha RB, Telles JPM, Neto EB, Figueiredo EG. Development and adaptations of the Graded Prognostic Assessment (GPA) scale: a systematic review. Clin Exp Metastasis 2023; 40:445-463. [PMID: 37819546 DOI: 10.1007/s10585-023-10237-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
The Graded Prognostic Assessment (GPA) score has the best accuracy among prognostic scales for patients with brain metastases (BM). A wide range of GPA-derived scales have been established to different types of primary tumor BM. However, there is a high variability between them, and their characteristics have not been described altogether yet. We aim to summarize the features of the existent GPA-derived scales and to compare their predictor factors and their uses in clinical setting. Medline was searched from inception until January 2023 to identify studies related to the development, update, or validation of GPA. The initial search yielded 1,083 results. 16 original studies and 16 validation studies were included, comprising a total of 33,348 patients. 13 different scales were assessed, including: GPA, Diagnosis-Specific GPA, Extracranial Score, Lung-molGPA, Updated Renal GPA, Updated Gastrointestinal GPA, Modified Breast GPA, Integrated Melanoma GPA, Melanoma Mol GPA, Sarcoma GPA, Hepatocellular Carcinoma GPA, Colorectal Cancer GPA, and Uterine Cancer GPA. The most prevalent prognostic predictors were age, Karnofsky Performance Status, number of BM, and presence or absence of extracranial metastases. Treatment modalities consisted of whole brain radiation therapy, stereotactic radiosurgery, surgery, cranial radiotherapy, gamma knife radiosurgery, and BRAF inhibitor therapy. Median survival rates with no treatment and with a specific treatment ranged from 6.1 weeks to 33 months and from 3.1 to 21 months, respectively. Original GPA and GPA-derived scales are valid prognostic tools, but with heterogeneous survival results when compared to each other. More studies are needed to improve scientific evidence of these scales.
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Affiliation(s)
| | | | | | | | - Eliseu Becco Neto
- Division of Neurosurgery, University of São Paulo, São Paulo, Brazil
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Brain Metastases from Uterine Cervical and Endometrial Cancer. Cancers (Basel) 2021; 13:cancers13030519. [PMID: 33572880 PMCID: PMC7866278 DOI: 10.3390/cancers13030519] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary This review investigated the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of patients with brain metastases from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC). The findings of this review indicate the factors that can facilitate better treatment selection and, consequently, better outcomes in patients with CC and EC. Abstract Reports on brain metastases (BMs) from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC) have recently increased due to the development of massive databases and improvements in diagnostic procedures. This review separately investigates the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of BMs from CC and uterine endometrial carcinoma EC. For patients with CC, early-stage disease and poorly differentiated carcinoma lead to BMs, and elderly age, poor performance status, and multiple BMs are listed as poor prognostic factors. Advanced-stage disease and high-grade carcinoma are high-risk factors for BMs from EC, and multiple metastases and extracranial metastases, or unimodal therapies, are possibly factors indicating poor prognosis. There is no “most effective” therapy that has gained consensus for the treatment of BMs. Treatment decisions are based on clinical status, number of the metastases, tumor size, and metastases at distant organs. Surgical resection followed by adjuvant radiotherapy appears to be the best treatment approach to date. Stereotactic ablative radiation therapy has been increasingly associated with good outcomes in preserving cognitive functions. Despite treatment, patients died within 1 year after the BM diagnosis. BMs from uterine cancer remain quite rare, and the current evidence is limited; thus, further studies are needed.
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Sun S, Lian X, Liu X, Ma J, Hou X, Zhang F, Hu K. Multimodal Therapy is a Better Choice for Patients with Brain Metastasis from Cervical Cancer. Cancer Manag Res 2020; 12:12395-12402. [PMID: 33293865 PMCID: PMC7719318 DOI: 10.2147/cmar.s283673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the prognostic factors and optimal management of cervical cancer patients with brain metastasis (BM). Materials and Methods We retrospectively reviewed the medical records of 7098 consecutive patients with cervical cancer from January 2000 to December 2019. Data for a total of 24 BM patients with cervical cancer were analyzed retrospectively in the present study. Results The incidence of BM from cervical cancer in our institution was 0.38%. The mean survival time was 7.2 months (median 6.2 months, 0.1–21.2 months). In the univariate analysis, the histopathology of neuroendocrine cancer, 2018 FIGO stage, Karnofsky performance status (KPS) at BM diagnosis, and treatment strategy were identified to be significant prognostic indicators for the survival of patients with BM from cervical cancer. In the multivariate analysis, KPS, chemotherapy, and radiotherapy were independent prognostic factors for survival. Recursive partition analysis (RPA) appeared to be a better prognostic tool than the other prognosis scoring classification systems. Conclusion When patients with BM from cervical cancer have good performance status and undergo comprehensive treatment, such as radiotherapy and chemotherapy, their survival time could be significantly prolonged. Patients with surgical indications may get better survival by postoperative radiotherapy and chemotherapy. Patients with BMs ≥3 may get better survival by whole-brain radiotherapy. But further studies are needed regarding the selection of surgical indications and radiotherapy modes. The prognosis scoring classification system for BM from cervical cancer needs to be improved.
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Affiliation(s)
- Shuai Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Jiabin Ma
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
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Zhou S, Peng F. Patterns of metastases in cervical cancer: a population-based study. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1615-1623. [PMID: 32782680 PMCID: PMC7414489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
UNLABELLED To investigate the incidence, prognosis, and treatment modality of different metastatic sites in cervical cancer. METHODS We used the surveillance epidemiology and end results (SEER) database to collect cervical cancer patients with metastasis from 2010-2016. Kaplan-Meier survival analyses and log-rank tests were used to compare overall survival between groups. Univariate and multivariate Cox proportional hazards regression analyses were used for identifying the prognostic factors in metastatic cervical cancer. RESULTS In total, 1347 patients with distant metastatic cervical cancer were selected for the study. The average age of patients with metastatic cervical cancer was 57 years old. Unmarried white patients were the majority. About 7.9%, 53.3%, and 64.6% patients were treated with surgery, radiation, and chemotherapy, respectively. Additionally, lungs were the most common metastatic sites. The survivals of single-site metastases were similar, which were better than multi-organ metastases. Lung metastatic patients were older than other metastatic patients, and with poorer differentiation and higher stage tumors. In terms of treatment, bone metastatic patients were more commonly treated with radiotherapy (68.4%) than other metastatic patterns. Surgery, radiation, and chemotherapy all prolonged survival months of single-site and multi-site metastatic patients. Furthermore, age, ethnicity, tumor stage, surgery, radiotherapy, chemotherapy, and metastatic sites were independent prognostic factors for patients with metastatic cervical cancer. CONCLUSIONS This large-population based study showed that the most common metastatic site of cervical cancer is lung. Although lung metastatic patients harbor older ages and poorer differentiation and higher stage tumors than other sites, the prognosis of lung metastasis is similar to other single metastatic sites. However, the single-site metastatic patients survive longer than multi-site metastatic patients. Surgery, radiotherapy, and chemotherapy all bring benefit to patients with metastases, which may guide the treatment in metastatic cervical cancers.
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Affiliation(s)
- Shu Zhou
- Department of Pathology, Zhejiang Hospital Hangzhou 310013, Zhejiang Province, China
| | - Fang Peng
- Department of Pathology, Zhejiang Hospital Hangzhou 310013, Zhejiang Province, China
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Ogino A, Hirai T, Serizawa T, Yoshino A. Gamma Knife Surgery for Brain Metastases from Uterine Malignant Tumor. World Neurosurg 2020; 139:e363-e372. [PMID: 32305598 DOI: 10.1016/j.wneu.2020.03.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Uterine malignant tumors (uterine cervical carcinoma [UCC], uterine endometrial carcinoma, and uterine sarcoma) are common in women. Brain metastases from uterine malignant tumors are rare, but its incidence has been increasing. The present study aimed to investigate the characteristics of brain metastases from uterine malignant tumors, evaluate predictive factors, and assess the efficacy of Gamma Knife surgery (GKS) for metastases from uterine malignant tumors. METHODS We retrospectively reviewed the records of patients with brain metastases from uterine malignant tumors treated at Tokyo Gamma Unit Center from 2005 to 2017. RESULTS We identified 37 patients: 16 had UCC, 12 had uterine endometrial carcinoma, and 9 had uterine sarcoma. Their median age at diagnosis of brain metastases was 54.0 years. The median interval from diagnosis of uterine malignant tumor to brain metastases was 21.0 months, the median number of brain metastases was 3.0, and the median Karnofsky Performance Status at first GKS was 80%. The median survival after first GKS was 6.0 months. All patients had other metastases. Six-month and 1-year survival after first GKS were 48.9% and 32.6%, respectively, and the tumor control rate at 6 months after GKS was 90.8%. Brain metastases from UCC were significantly correlated with good tumor control (P = 0.024). Multivariate analysis determined that Karnofsky Performance Status was significantly associated with patient survival (P = 0.001). CONCLUSIONS The results of our study suggest that GKS is an acceptable choice for controlling brain metastases from uterine malignant tumors. In particular, GKS provides excellent local control for metastases from UCC.
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Affiliation(s)
- Akiyoshi Ogino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
| | - Tatsuo Hirai
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan
| | - Toru Serizawa
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
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Kim H, Lee KK, Heo MH, Kim JY. The prognostic factors influencing overall survival in uterine cervical cancer with brain metastasis. Korean J Intern Med 2019; 34:1324-1332. [PMID: 30360020 PMCID: PMC6823565 DOI: 10.3904/kjim.2018.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/02/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The occurrence of brain metastasis (BM) has increased due to improved overall survival (OS) in uterine cervical cancer. However, research about prognostic factors and therapeutic guidelines for BM in uterine cervical cancer remains scarce due to the rarity of BM in this type of cancer. The present study evaluated the clinical characteristics and prognostic factors influencing OS in patients with BM from uterine cervical cancer. METHODS A total of 19 BM patients of uterine cervical cancer were analyzed retrospectively from January 1995 to December 2016. RESULTS The median and mean OS of all patients was 9.6 and 15.4 months. Treatment (vs. palliative care, p < 0.001), fewer than three regimens of chemotherapy before BM (vs. ≥ 3, p < 0.013), and chemotherapy after BM (vs. absence, p < 0.001) significantly increased the OS time. The Karnofsky performance status ≥ 70 (vs. < 70, p = 0.213), single BM (vs. multiple BM, p = 0.157), and small cell carcinoma (vs. others, p = 0.351) had numerically higher OS than others. Dual therapy (vs. single therapy, p = 0.182; vs. no therapy, p = 0.076) were associated with a longer OS time, but the difference did not reach statistical significance. In addition, the graded prognostic assessment (GPA) appeared to be a better prognostic tool than the recursive partitioning analysis. CONCLUSION The results of the present study suggest active multimodal treatment including neurosurgery, radiotherapy, and chemotherapy for BM of uterine cervical cancer with single BM, good performance status, histology of small cell carcinoma, and a better GPA.
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Affiliation(s)
- Hyera Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- Correspondence to Hyera Kim, M.D. Division of Hematology and Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: +82-53-250-8434 Fax: +82-53-250-7434 E-mail:
| | - Kang Kook Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Mi Hwa Heo
- Division of Hematology and Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jin Young Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
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Pathologically confirmed brain metastases from primary uterine cervical tumors: two cases and a literature review. World J Surg Oncol 2019; 17:174. [PMID: 31672152 PMCID: PMC6824018 DOI: 10.1186/s12957-019-1720-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/03/2019] [Indexed: 12/26/2022] Open
Abstract
Background Pathologically confirmed brain metastasis from primary cervical cancer is extremely rare. Herein, we report two cases of intracranial metastasis from cervical cancer that were histopathologically confirmed after surgical excision. In addition, we conducted a literature review to characterize the clinical manifestation, pathogenesis, and treatment of these patients. Case summary Among the 1800 patients with primary cervical cancer who received therapy at our center from 2010 to 2018, two patients (0.1%) had definite histopathological evidence of brain metastasis. A 46-year-old female who had a history of poorly differentiated stage IIB cervical cancer with neuroendocrine differentiation presented with a solitary mass in the right occipital lobe 26 months after the initial diagnosis. She underwent surgery and chemotherapy but died of disease progression 9 months later. Another 55-year-old female diagnosed with poorly differentiated stage IVB cervical squamous cancer presented with a solitary mass in the right frontal lobe 16 months after simple hysterectomy. Twelve months later, multiple lesions were observed in the bilateral frontal-parietal lobe. The lesions were treated by surgery and stereotactic radiosurgery. The patient died of multiple organ failure 14 months later. Conclusion The pathogenesis and best management of brain metastasis from cervical cancer are not clear. Highly invasive subtypes or advanced cancer stages may be the key clinicopathological factors of brain metastasis. Surgical treatment is warranted in patients with a good health status and without metastasis to other sites.
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