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Abstract Background Brain metastases from sarcomatous lesions pose a management challenge owing to their rarity and the histopathological heterogeneity. Prognostic indices such as the Graded Prognostic Assessment (GPA) index have been developed for several primary tumour types presenting with brain metastases (e.g. lung, breast, melanoma), tailored to the specifics of different primary histologies and molecular profiles. Thus far, a prognostic index to direct treatment decisions is lacking for adult sarcoma patients with brain metastases. Methods We performed a multicentre analysis of a national group of expert sarcoma tertiary centres (French Sarcoma Group, GSF-GETO) with the participation of one Canadian and one Swiss centre. The study cohort included adult patients with a diagnosis of a bone or soft tissue sarcoma presenting parenchymal or meningeal brain metastases, managed between January 1992 and March 2012. We assessed the validity of the original GPA index in this patient population and developed a disease-specific Sarcoma-GPA index. Results The original GPA index is not prognostic for sarcoma brain metastasis patients. We have developed a dedicated Sarcoma-GPA index that identifies a sub-group of patients with particularly favourable prognosis based on histology, number of brain lesions and performance status. Conclusions The Sarcoma-GPA index provides a novel tool for sarcoma oncologists to guide clinical decision-making and outcomes research.

Background Brain metastases (BM) from adult soft tissue or bone sarcomas are rare, and sparse data exist on their prognostic factors and management. Subjects, Materials and Methods A retrospective study was conducted in 15 centers of the French Sarcoma Group, plus one Canadian and one Swiss center, to report on clinical, histological, and treatment characteristics and to identify predictive factors of outcome. Results Between 1992 and 2012, 246 patients with a median age of 50 years (range: 16–86) were managed for BM. BM included 221 cerebral and cerebellar metastases and 40 cases of meningeal sarcomatosis. The most frequent histopathological subtype was leiomyosarcoma (18.7%). Histological grade was high in 118 (48%) cases. Surgery of BM was carried out for 38 (15.5%) patients. Radiotherapy and chemotherapy were administered in 168 (68.3%) and 91 (37.0%) patients, respectively. Irrespective of treatment modality, BM were controlled in 113 patients (45.9%), including 31 partial responses (12.6%) and 18 complete responses (7.3%). The median overall survival from diagnosis of brain metastasis was 2.7 months (range: 0–133). In the multivariate analysis, the following parameters influenced overall survival: chemotherapy (hazard ratio [HR] = 0.38; 95% confidence interval [CI]: 0.26–0.48), surgery (HR = 0.40; 95% CI: 0.22–0.72), stereotactic radiotherapy (HR = 0.41; 95% CI: 0.19–0.90), whole-brain radiotherapy (HR = 0.51; 95% CI: 0.35–0.76), and grade (HR = 0.65; 95% CI: 0.43–0.98). Conclusion BM of sarcomas are rare and associated with a dismal outcome. Multidisciplinary management with chemotherapy, radiation therapy, and surgery is associated with a better survival. Implications for Practice The incidence of brain and meningeal metastasis in bone and soft tissue sarcomas is estimated between 1% and 8%. Published data are derived from small retrospective case series, often in the pediatric population. A prognostic index is important to guide both clinical decision-making and outcomes research, but one such is lacking for adult sarcoma patients with brain metastases. The current study describes brain metastasis in a large cohort of sarcoma patients. This study, conducted within the French Sarcoma Group, describes the natural history of sarcoma brain metastasis and enables the proposal of strategic recommendations for subsequent clinical trials and for the management of such patients.

BACKGROUND: The assessment of Bevacizumab efficacy in high-grade gliomas (HGG) depends on the response criteria used, with discrepancies between T1 Gadolinium-enhanced sequences, T2 sequences and neurological outcome. The aim was to compare McDonald's, RANO and RECIST 1.1 criteria to the clinical outcome in a consecutive series of HGG patients. METHODS: HGG patients treated at the Montpellier Cancer Institute were retrospectively selected. Patients with a Performance Status (PS) 20% of the product of perpendicular diameters. CONCLUSIONS: The high correlation between McDonald's and RANO criteria demonstrates the importance of accurately assessing changes in steroids and neurological state, as well as imaging response, in order to avoid concluding to a false efficacy on imaging only, when using the McDonald's criteria. These results raise the question of the value of the FLAIR assessment when McDonald's criteria are rigorously applied.