ArticleInternational journal of radiation oncology, biology, physics2020
Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today.
Article in International journal of radiation oncology, biology, physics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 104 papers, 2 of them syntheses that pooled it.
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Who cites it
104 citing papers in PubMed, 2 syntheses or guidelines pooled it, 142 citations in OpenAlex.
- SEOM-GEICAM-SOLTI clinical guidelines in advanced breast cancer (UPDATE 2025).Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Guideline
- DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2024Guideline
- A phase II study of atezolizumab in combination with stereotactic radiation for patients with triple-negative breast cancer and brain metastasis.Breast cancer research and treatment · 2026Trial
- A Phase II Study of Atezolizumab, Pertuzumab, and High-Dose Trastuzumab for Central Nervous System Metastases in Patients with HER2-Positive Breast Cancer.Clinical cancer research : an official journal of the American Association for Cancer Research · 2024Trial
- Enhanced prognostic score for breast cancer brain metastases incorporating contemporary clinical features and leptomeningeal disease: Development and validation.Breast (Edinburgh, Scotland) · 2026Article
- Review
- Prediction of Outcomes of Brain Irradiation in Correlation with Molecular Subtypes in Patients with Metastatic Breast Cancer.Asian Pacific journal of cancer prevention : APJCP · 2026Article
- Biological aging enhances prognostic stratification beyond chronological age in breast cancer brain metastases.Journal of neuro-oncology · 2026Article
- Cognitive function in long-term survivors after treatment for brain metastases compared with normative samples.Neuro-oncology practice · 2026Article
- Temporal Dynamics and Heterogeneity in Brain Metastases: A Single-Center Retrospective Analysis of Vulnerabilities in Current MRI Surveillance Practices.Medicina (Kaunas, Lithuania) · 2026Observational
- Chinese Society of Clinical Oncology breast cancer expert consensus on the diagnosis and treatment of breast cancer brain metastasis (2025).Translational breast cancer research : a journal focusing on translational research in breast cancer · 2026Review
- Radiotherapeutic management of brain metastases in patients with breast cancer: a narrative review.Translational breast cancer research : a journal focusing on translational research in breast cancer · 2026Review
- Clinical outcomes and survival benefits of craniotomy in breast cancer patients with brain metastases: Focusing on candidate selection and early mortality.Brain & spine · 2026Article
- Assessment of real-world surveillance strategies for patients undergoing systemic therapy for brain metastases.Frontiers in oncology · 2026Article
- Concurrent systemic treatment during stereotactic radiosurgery for breast cancer brain metastasis - analysis of survival outcomes and propensity score matching analysis.Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology · 2026Article
- Clinical subtypes in breast cancer patients with brain metastases from an ambispective registry of advanced breast cancer, GEICAM/2014-03 (RegistEM).Therapeutic advances in medical oncology · 2026Article
- Factors associated with developing and surviving brain metastases in patients with breast cancer: a multi-center experience.BMC cancer · 2025Article
- Sacituzumab govitecan and stereotactic radiosurgery in the management of HER2 negative breast cancer brain metastases: a multi-institutional report.Journal of neuro-oncology · 2025Article
- Clinical-pathological patterns and prognosis of young women with breast cancer brain metastases: a single-center retrospective study.Journal of neuro-oncology · 2025Article
- Article
44 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
Authors and funding
39 authors at 19 institutions in 2 countries.
Funding
Abstract
purposeBrain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts. METHODS AND MATERIALS: A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively.
resultsMedian survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01).
conclusionsMS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
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