# Graded Prognostic Assessment (GPA) for brain metastases

Source: https://onco.cc/terms/graded-prognostic-assessment/  
OnCo record `graded-prognostic-assessment` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The GPA is a points score (age, performance status, number of brain metastases, spread outside the brain, and for some cancers the tumour's mutations) that estimates survival for a patient with brain metastases from a few months to several years, and it is what oncologists use to decide whether aggressive local treatment like radiosurgery is worth it.

## Summary

What is measured: expected survival after a diagnosis of brain metastases, by primary tumour. How: age, Karnofsky performance status, the number of metastases on contrast MRI, extracranial disease and, in the molecular versions, the tumour's driver status: EGFR and ALK (and PD-L1 in the 2021 update) for lung adenocarcinoma, BRAF for melanoma and receptor subtype for breast cancer, scored in half-points to a maximum of 4. In lung adenocarcinoma a score of 3.5 to 4 predicts a median survival near four years against about seven months for 0 to 1 (Sperduto and colleagues). Brain metastasis velocity (new lesions per year after radiosurgery) predicts the need for salvage, and the older RPA classes are the ancestor. What a result changes: a poor score (under 1.5) argues for best supportive care or whole-brain radiotherapy, which in the QUARTZ trial did not lengthen life over steroids alone in poor-prognosis lung cancer, and against surgery; a good score supports surgery for large or symptomatic lesions with radiosurgery to the cavity, radiosurgery rather than whole-brain treatment for up to ten or more metastases to preserve cognition, hippocampal-avoidance whole-brain radiotherapy with memantine when the whole brain must be treated, and, in asymptomatic patients with a brain-active drug available (osimertinib, lorlatinib, tucatinib, trastuzumab deruxtecan, ipilimumab with nivolumab), systemic therapy first; it also sets trial eligibility. Where it matters: secondary brain tumours and HER2-positive breast cancer brain metastases.

## Fields

- Kind: Term
- Last checked: 2026-09-17
- Also known as: GPA; graded prognostic assessment; diagnosis-specific GPA; ds-GPA; DS-GPA; molecular GPA; Lung-molGPA; Melanoma-molGPA; Breast-GPA; RPA class; recursive partitioning analysis for brain metastases; brain metastases prognostic index; brain metastasis velocity

## Connected records

- terms: [Brain metastases (intracranial disease)](https://onco.cc/terms/brain-metastases/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/), [Radiotherapy](https://onco.cc/terms/radiotherapy/), [Stereotactic radiosurgery (SRS)](https://onco.cc/terms/stereotactic-radiosurgery/)
- drugs: [Lorlatinib](https://onco.cc/drugs/lorlatinib/), [Osimertinib](https://onco.cc/drugs/osimertinib/)
- cancers: [Brain metastases (secondary brain tumours)](https://onco.cc/cancers/secondary-brain-tumours/), [HER2-positive breast cancer with brain metastases](https://onco.cc/cancers/her2-positive-breast-brain-metastases/)

---
JSON: https://onco.cc/api/v1/entities/graded-prognostic-assessment.json