Difficulties in predicting survival for brain metastasis patients is underappreciated and has ramifications for cost-effective care. Kondziolka et al. assessed the ability of clinicians to predict survival in 150 cancer patients undergoing stereotactic radiosurgery for brain metastases from 2009-11. Clinicians included 7 neurosurgeons, 6 radiation oncologists, and 5 medical/neuro-oncologists. Patients were grouped by RPA class (23 Class I = age < 65, KPS ≥0, controlled primary tumor, no extracranial disease; 5 Class 3 = KPS < 70; 122 Class 2 = patients not in Classes 1 or 3). Primary diagnoses included non-small cell lung cancer (65), breast cancer (30), and melanoma (21). Median patient survival was 10.3 months; median clinician-predicted survival was 9.7 months (11.8 months for neurosurgeons, 11.0 months for radiation oncologists, and 7.2 months for oncologists). Subgroup analysis revealed great variability and difficulty in predicting survival despite published clinical data and population-based guidelines, therefore the authors advise patient-specific clinical management decisions.
Journal of Neurosurgery