Etablierung eines Registers zur prospektiven Evaluation des „disease specific graded prognostic assessment scores“

Die Inzidenz von Hirnmetastasen nimmt stetig zu und stellt eine ernste Komplikation von soliden Karzinomen dar. Unbehandelt ist die Prognose mit etwa einem Monat nahezu infaust. In diesem meist palliativen Krankheitsstadium ist die Intensität der eventuell nebenwirkungsreichen Therapie zur Verlänger...

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Bibliographic Details
Main Author: Schäfer, Wibke
Contributors: Burchert, Andreas (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2023
Online Access:PDF Full Text
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The incidence of brain metastases as a serious complication of solid carcinomas is rising steadily. Without therapy, the prognosis is unfavorable with a median survival of one month. In this palliative setting, the intensity of treatment with the intent to prolong survival has to be weighed against possible side effects compromising the patient’s quality of life. To provide the treating physician with assistance for reasonable decision-making, Sperduto et al. developed the diagnosis specific graded prognostic assessment score (DS-GPA) to estimate the individual patient’s survival. The purpose of this paper is the establishment of a clinical trial named “prospective evaluation of the DS-GPA (PEGPA)”, which is based on retrospective data. A study protocol was composed and a matrix for documentation and evaluation of data was developed. A statistical test to assess reliability of estimated survival time was designed. As demonstration of practicability of this study as well as the statistical analysis, an interim analysis of the first 30 patients included was performed. Collection and documentation of source data to calculate median survival with the DS-GPA worked well. With the designed statistical test, the prognosis calculated per DS-GPA was reliable only for 5 out of 28 patients. Results of this paper can provide a foundation to continue the trial as register study. Because of the reliability of documentation, the PEGPA-register can serve as a tool for quality assurance. The benefit of estimating survival time with DS-GPA cannot be proven by the results of interim analysis, although clearly more data has to be collected with the installed PEGPA-register. Progress in systemic tumor therapy, especially development of targeted and immunotherapy, as well as stereotactic radiation could contribute to invalidate in part the applicability of the DS-GPA as prognosis score for patients with brain metastases.