{"entity":{"id":"graded-prognostic-assessment","kind":"term","name":"Graded Prognostic Assessment (GPA) for brain metastases","aka":["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"],"tldr":"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.","asOf":"2026-09-17","links":[],"tags":[],"related":["performance-status","brain-metastases","stereotactic-radiosurgery","radiotherapy","osimertinib","lorlatinib"],"cancers":["secondary-brain-tumours","her2-positive-breast-brain-metastases"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Biomarkers"},"route":"/terms/graded-prognostic-assessment/","neighbours":{"term":[{"id":"brain-metastases","kind":"term","name":"Brain metastases (intracranial disease)","route":"/terms/brain-metastases/"},{"id":"performance-status","kind":"term","name":"Performance status (ECOG, Karnofsky)","route":"/terms/performance-status/"},{"id":"radiotherapy","kind":"term","name":"Radiotherapy","route":"/terms/radiotherapy/"},{"id":"stereotactic-radiosurgery","kind":"term","name":"Stereotactic radiosurgery (SRS)","route":"/terms/stereotactic-radiosurgery/"}],"drug":[{"id":"lorlatinib","kind":"drug","name":"Lorlatinib","route":"/drugs/lorlatinib/"},{"id":"osimertinib","kind":"drug","name":"Osimertinib","route":"/drugs/osimertinib/"}],"cancer":[{"id":"secondary-brain-tumours","kind":"cancer","name":"Brain metastases (secondary brain tumours)","route":"/cancers/secondary-brain-tumours/"},{"id":"her2-positive-breast-brain-metastases","kind":"cancer","name":"HER2-positive breast cancer with brain metastases","route":"/cancers/her2-positive-breast-brain-metastases/"}]}}