Neuro-Oncology Practice XX(XX), 1–6, 2023 | https://doi.org/10.1093/nop/npad047 | Advance Access date 7 August 2023 1 © The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. Hadleigh Cuthbert , Max Riley, Shreya Bhatt, Claudia Kate Au-Yeung, Ayesha Arshad, Sondos Eladawi, Athanasios Zisakis, Georgios Tsermoulas, Colin Watts † , and Victoria Wykes † All author affiliations are listed at the end of the article Corresponding Author: Hadleigh Cuthbert, MBBS, BSc, Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham B15 2TH, UK (hadleigh.cuthbert@nhs.net) † Joint senior authors. Abstract Background. Brain metastases account for more than 50% of all intracranial tumors and are associated with poor outcomes. Treatment decisions in this highly heterogenous cohort remain controversial due to the myriad of treat- ment options available, and there is no clearly defined standard of care. The prognosis in brain metastasis patients varies widely with tumor type, extracranial disease burden and patient performance status. Decision-making re- garding treatment is, therefore, tailored to each patient and their disease. Methods. This is a retrospective cohort study assessing survival outcomes following surgery for brain metastases over a 50-month period (April 1, 2014–June 30, 2018). We compared predicted survival using the diagnosis-specific Graded Prognostic Assessment (ds-GPA) with actual survival. Results. A total of 186 patients were included in our cohort. Regression analysis demonstrated no significant cor- relation between actual and predicted outcome. The most common reason for exclusion was insufficient informa- tion being available to the neuro-oncology multidisciplinary team (MDT) meeting to allow GPA calculation. Conclusions. In this study, we demonstrate that “predicted survival” using the ds-GPA does not correlate with “actual survival” in our operated patient cohort. We also identify a shortcoming in the amount of information avail- able at MDT in order to implement the GPA appropriately. Patient selection for aggressive therapies is crucial, and this study emphasizes the need for treatment decisions to be individualized based on patient and cancer clinical characteristics. Keywords brain metastases | graded prognostic assessment | outcome | prognosis | resection Brain metastases (BMs) affect 40% of patients with extracranial primary cancers, making them the most common intracranial tumors. An estimated 16,000 patients are diagnosed with a brain metastasis annually in the UK, and this burden is expected to grow. 1,2 An increased emphasis on screening brain imaging for at-risk patients with metastatic cancer, 3 coupled with improved surveillance and systemic disease control, will contribute to an increased burden of this disease. 4–6 The impact of BMs is signifi- cant for both patients and their families, having major effects on survival, and both cognitive and physical capabilities. Currently available treatment options for brain me- tastases include surgery, radiotherapy, and systemic pharmacotherapies. Treatment decisions remain controver- sial due to the heterogeneity of this patient cohort. Surgery has an important role to play in both tumor resection and for tissue diagnosis in cases where the primary cancer is unknown. The aim of surgical resection is maximum safe resection of the tumor, and this carries the advantages of: reducing mass effect, reducing dependence on steroids, and improving progression-free and overall survival with preservation of functional capacity. 7 Radiation therapy is recommended for all patients following resection of brain metastases and improves intracranial control and survival outcomes. 8 Utility of a prognostic assessment tool to predict survival following surgery for brain metastases This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https:// creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Downloaded from https://academic.oup.com/nop/advance-article/doi/10.1093/nop/npad047/7238419 by guest on 31 August 2023