Graded Prognostic Assessment for GI Cancer (GI-GPA)
Graded Prognostic Assessment for gastrointestinal cancers with newly diagnosed brain metastases (updated GI-GPA, Sperduto 2019). Uses KPS, age, extracranial metastases and number of brain metastases (0-4); median survival 3 months for 0-1.0 to 17 months for 3.5-4.0. Guides prognosis and treatment decisions (SRS vs WBRT vs supportive care).
Score interpretation
GI-GPA 0-1.0 -- median survival about 3 months (Sperduto 2019)
→ Best supportive care likely most appropriate; steroids for symptom control of cerebral oedema; WBRT may be considered for symptomatic relief but limited survival benefit; hospice or palliative care referral; goals of care discussion with patient and family; DNACPR and advance care planning; ensure community palliative care and district nurse support; avoid aggressive investigation or treatment in last weeks of life; symptom control: steroids, anti-epileptics if seizures, analgesics; document ceiling of treatment in notes.
GI-GPA 1.5-2.0 -- median survival about 7-9 months
→ SRS for limited brain metastases (1-3 lesions) if feasible; WBRT as alternative for multiple brain metastases; discuss balance between local brain control and systemic disease management; palliative care involvement for symptom management; dexamethasone for oedema (adults: 4-8 mg/day) -- wean as tolerated; assess for clinical trial eligibility; carer and family support; document treatment intent (radical vs palliative) clearly in notes. Children: use a children's formulary.
GI-GPA 2.5-3.0 -- median survival about 11-12 months
→ SRS for limited brain metastases (1-3 lesions) if feasible; WBRT as alternative for multiple brain metastases; discuss balance between local brain control and systemic disease management; palliative care involvement for symptom management; dexamethasone for oedema (adults: 4-8 mg/day) -- wean as tolerated; assess for clinical trial eligibility; carer and family support; document treatment intent (radical vs palliative) clearly in notes. Children: use a children's formulary.
GI-GPA 3.5-4.0 -- median survival about 17 months
→ Aggressive local treatment of brain metastases appropriate: stereotactic radiosurgery (SRS) preferred for 1-3 lesions (superior local control, less neurocognitive toxicity than WBRT); neurosurgical resection if single accessible lesion and good systemic control; discuss with neuro-oncology MDT; optimise systemic therapy (including immunotherapy if appropriate); quality of life and neurological function preservation as primary goals; close follow-up with MRI brain every 2-3 months; document in cancer care summary.
Interpretation bands for the GI-GPA. Apply clinical judgement and local guidance.
References
- Sperduto PW, et al. Estimating survival in patients with gastrointestinal cancers and brain metastases: an update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA). Clin Transl Radiat Oncol. 2019;18:39-45.
- Sperduto PW et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77(3):655-661.
Related
Curated clinical cross-links plus same-class fallbacks.
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.