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McTyre ER, Soike MH, Farris M, Ayala-Peacock DN, Hepel JT, Page BR, Shen C, Kleinberg L, Contessa JN, Corso C, Chiang V, Henson-Masters A, Cramer CK, Ruiz J, Pasche B, Watabe K, D'Agostino R, Su J, Laxton AW, Tatter SB, Fiveash JB, Ahluwalia M, Kotecha R, Chao ST, Braunstein SE, Attia A, Chung C, Chan MD. Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery. Radiother Oncol 2019; 142:168-174. [PMID: 31526671 DOI: 10.1016/j.radonc.2019.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Brain metastasis velocity (BMV) is a prognostic metric that describes the recurrence rate of new brain metastases after initial treatment with radiosurgery (SRS). We have previously risk stratified patients into high, intermediate, and low-risk BMV groups, which correlates with overall survival (OS). We sought to externally validate BMV in a multi-institutional setting. METHODS Patients from nine academic centers were treated with upfront SRS; the validation cohort consisted of data from eight institutions not previously used to define BMV. Patients were classified by BMV into low (<4 BMV), intermediate (4-13 BMV), and high-risk groups (>13 BMV). Time-to-event outcomes were estimated using the Kaplan-Meier method. Cox proportional hazards methods were used to estimate the effect of BMV and salvage modality on OS. RESULTS Of 2829 patients, 2092 patients were included in the validation dataset. Of these, 921 (44.0%) experienced distant brain failure (DBF). Median OS from initial SRS was 11.2 mo. Median OS for BMV < 4, BMV 4-13, and BMV > 13 were 12.5 mo, 7.0 mo, and 4.6 mo (p < 0.0001). After multivariate regression modeling, melanoma histology (β: 10.10, SE: 1.89, p < 0.0001) and number of initial brain metastases (β: 1.52, SE: 0.34, p < 0.0001) remained predictive of BMV (adjusted R2 = 0.06). CONCLUSIONS This multi-institutional dataset validates BMV as a predictor of OS following initial SRS. BMV is being utilized in upcoming multi-institutional randomized controlled trials as a stratification variable for salvage whole brain radiation versus salvage SRS after DBF.
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Affiliation(s)
- Emory R McTyre
- Department of Radiation Oncology, Greenville Health System Cancer Institute, USA
| | - Michael H Soike
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, USA.
| | - Michael Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, USA
| | | | - Jaroslaw T Hepel
- Department of Radiation Oncology, Brown University Alpert Medical School, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins School of Medicine, USA
| | - Colette Shen
- Department of Radiation Oncology, University of North Carolina, USA
| | | | | | | | | | | | | | - Jimmy Ruiz
- Department of Medicine, Wake Forest School of Medicine, USA
| | - Boris Pasche
- Department of Medicine, Wake Forest School of Medicine, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, USA
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Jing Su
- Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, USA
| | | | - John B Fiveash
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, USA
| | - Manmeet Ahluwalia
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, USA
| | - Samuel T Chao
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University School of Medicine, USA
| | - Caroline Chung
- Department of Radiation Oncology, M.D. Anderson Cancer Center, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, USA
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