Graded Prognostic Assessment for GI Cancer (GI-GPA)
Graded Prognostic Assessment (GPA) adapted for gastrointestinal cancers with brain metastases. Guides prognosis and treatment decisions (SRS vs WBRT vs palliative). GI-GPA score 0-4: score 0-1.0 = poor prognosis (median survival 3 months); score 3.5-4.0 = best prognosis (median survival 13.5 months). From Sperduto et al. 2012.
Score interpretation
GI-GPA 3.0-4.0 -- best prognosis group; median OS approximately 13.5 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.
GI-GPA 1.5-2.5 -- intermediate prognosis; median OS approximately 5-8 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 (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.
GI-GPA 0-1.0 -- poor prognosis group; median OS approximately 3 months
→ 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.
Interpretation bands for the GI-GPA. Apply clinical judgement and local guidance.
References
- 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.
- Sperduto CM et al. The graded prognostic assessment for gastrointestinal cancer brain metastases. J Neurooncol. 2012;110(3):447-452.
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.