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Prognostic models for patients with brain metastases after stereotactic radiosurgery with or without whole brain radiotherapy: a validation study

  • Clinical Study
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Abstract

Purpose/Objective(s)

To compare the performance of five prognostic models [RTOG recursive partitioning analysis (RPA), Score Index for Radiosurgery in Brain Metastases (SIR), Barnholtz-Sloan–Kattan nomogram (BSKN), diagnosis-specific Graded Prognostic Assessment (dsGPA), and Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA)] against actual survival in patients with brain metastases treated with SRS +/− WBRT.

Materials/Methods

100 consecutive patients treated with SRS +/− WBRT between January 2006 and July 2012 were retrospectively analyzed. Patients were binned according to 33 percentiles of the predicted survival distribution for the BSKN and dsGPA models to compare with LungmolGPA, RPA and SIR. Pearson’s correlation coefficients between predicted and observed survival were estimated to quantify the proportion of variance in observed survival.

Results

Median survival for the entire cohort was 13.5 months, with predicted vs actual MS by BSKN, SIR, dsGPA, RPA, adenocarcinoma Lung-molGPA, and nonadenocarcinoma Lung-molGPA was 3.8 vs 15.6 months, 7 vs 13.5 months, 9.4 vs 13.5 months, 10.3 vs 13.5 months, 13.7 vs 13.7 months, and 9.8 vs 9.7 months, respectively. The BSKN model and adenocarcinoma LungmolGPA created three groups with a statistically significantly different MS (p = 0.002 and p = 0.01, respectively).

Conclusion

All models under-predicted MS and only the BSKN and Lung-molGPA model stratified patients into three risk groups with statistically significant actual MS. The prognostic groupings of the adenocarcinoma Lung-molGPA group was the best predictor of MS, and showed that we are making improvements in our prognostic ability by utilizing molecular information that is much more widely available in the current treatment era.

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Funding

No outside funding was used for this project.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA

    Stephanie R. Rice, Andrew Hanna, Enid Choi, Young Kwok, William F. Regine, Cedric Yu & Terri F. Biggins

  2. Department of Epidemiology and Public Health, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Søren M. Bentzen

  3. Hazelrig Salter Radiation Oncology Center, University of Alabama Birmingham, Birmingham, AL, UK

    Drexell H. Boggs

  4. Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, MI, USA

    Jalal Hyder

  5. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA

    Steven J. Feigenberg

  6. Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA

    Graeme F. Woodworth & Howard M. Eisenberg

  7. Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Jill S. Barnholtz-Sloan

  8. Gamma Knife Center, University of Minnesota Medical Center, Minneapolis, MN, USA

    Paul W. Sperduto

  9. Hospital Israelita Albert Einstein, São Paulo, 04614-001, Brazil

    Eduardo Weltman

  10. University of São Paulo Medical School, São Paulo, Brazil

    Eduardo Weltman

  11. Miami Cancer Institute, Miami, FL, USA

    Minesh P. Mehta

Authors
  1. Stephanie R. Rice
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  2. Søren M. Bentzen
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  3. Andrew Hanna
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  9. William F. Regine
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  10. Graeme F. Woodworth
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  11. Howard M. Eisenberg
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  12. Cedric Yu
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  13. Terri F. Biggins
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  14. Jill S. Barnholtz-Sloan
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  15. Paul W. Sperduto
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  16. Eduardo Weltman
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  17. Minesh P. Mehta
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Contributions

SRR, SMB, MM, EW, PWS, JSBS, JH, AH, EC, DHB, YK, SJF, WFR, GFW, HME, CY contributed significantly to the experimental design. SRR, SMB, MM, JH, AH, EC, DHB, TB, and YK contributed significantly to its implementation, analysis and interpretation of the data. All authors were involved in the writing of the manuscript at draft and any revision stages, and have read and approved the final version.

Corresponding author

Correspondence to Søren M. Bentzen.

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Conflict of interest

MM has served as a consultant for Abbvie, Astra-Zeneca, Celgene, Oncoceutics, Tocagen, and Varian, serves on the DSMB for Monteris and on the BOD of Oncoceutics.

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Rice, S.R., Bentzen, S.M., Hanna, A. et al. Prognostic models for patients with brain metastases after stereotactic radiosurgery with or without whole brain radiotherapy: a validation study. J Neurooncol 140, 341–349 (2018). https://doi.org/10.1007/s11060-018-2958-6

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  • DOI: https://doi.org/10.1007/s11060-018-2958-6

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