Novel risk stratification score for predicting early distant brain failure and salvage whole-brain radiotherapy after stereotactic radiosurgery for brain metastases

• Type of Material: Article
• Authors: Robert H. Press, Emory University; Roshan S. Prabhu, Carolinas Healthcare System; Dana C. Nickleach, Emory University; Yuan Liu, Emory University; Hui-Kuo Shu, Emory University; Shravan Kandula, Emory University; Kirtesh Patel, Emory University; Walter Curran, Emory University; Ian Crocker, Emory University
• Language: English
• Date: 2015-11-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American Cancer Society.
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.29590
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 121
• Issue: 21
• Start Page: 3836
• End Page: 3843
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: Science & Technology; brain metastases; SURGICAL RESECTION; RANDOMIZED-TRIAL; Life Sciences & Biomedicine; TUMORS; MELANOMA; RECURSIVE PARTITIONING ANALYSIS; distant brain failure; PHASE-2 TRIAL; OPEN-LABEL; stereotactic radiosurgery; predictive modeling; Oncology; salvage whole-brain radiation therapy
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Background: The purpose of this study was to evaluate predictors of early distant brain failure (DBF) and salvage whole brain radiotherapy (WBRT) after treatment with stereotactic radiosurgery (SRS) for brain metastases and create a clinically relevant risk score in order to stratify patients’ risk of these events. Methods: We reviewed records of 270 patients with brain metastases treated with SRS between 2003-2012. Pre-treatment patient and tumor characteristics were analyzed by univariate and multivariable analyses. Cumulative incidence (CI) of first DBF and salvage WBRT were calculated. Significant factors were used to create a score for stratifying early (6-month) DBF risk. Results: No prior WBRT, total lesion volume <1.3 cm3, primary breast cancer or malignant melanoma histology, and multiple metastases (≥2) were found to be significant predictors for early DBF. Each factor was ascribed one point due to similar hazard ratios. Scores of 0-1, 2, and 3-4 were considered low, intermediate, and high risk, respectively. This correlated with 6-month CI of DBF of 16.6%, 28.8%, and 54.4%, respectively (p<0.001). For patients without prior WBRT, the 6-month CI of salvage WBRT by 6-months was 2%, 17.7%, and 25.7%, respectively (p<0.001). Conclusion: Early DBF after SRS requiring salvage WBRT remains a significant clinical problem. Patient stratification for early DBF can better inform the decision for initial treatment strategy for brain metastases. The provided risk score may help predict for early DBF and subsequent salvage WBRT if initial SRS is used. External validation is needed prior to clinical implementation.