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• W2273890916 abstract "Use of radiosurgery (SRS) for primary management of brain metastases is typically motivated by the desire to control intracranial disease and avoid whole brain radiation therapy (WBRT). This study aimed to devise a useful and convenient nomogram that predicts probability of surviving without salvage WBRT after SRS. Multi-institutional data were retrospectively collected from 1045 patients treated with SRS alone for newly diagnosed brain metastases. SRS was generally offered for limited brain metastases (1-4 lesions) in patients with KPS ≥70 and life expectancy ≥3 mo. Salvage WBRT was typically recommended for intracranial failures with >4 new lesions, KPS <70, or life expectancy <3 mo. WBRT-free survival was defined from date of SRS to date of salvage WBRT or death. Multiple patient, treatment, and disease variables were evaluated. Extracranial disease burden was defined as absent, oligometastatic (≤ 5 lesions), or widespread (>5 lesions). Kaplan-Meier method was used to estimate WBRT-free survival. Cox proportional hazard regression model was used for multivariate analysis. Significant prognostic factors for WBRT-free survival were identified and integrated to build a nomogram that was subjected to bootstrap internal validation. Median WBRT-free survival among all patients was 8 mo (range: 0.1-139 mo). The following were significant independent predictors for reduced WBRT-free survival (p<0.05): older age (HR=1.1 with each decade), more brain metastases (HR=1.1 with each additional lesion), presence of symptoms (HR=1.26), progressive systemic disease (HR=1.34), increasing extracranial disease burden [oligometastatic (HR=1.33), widespread (HR=1.59), each relative to none], and histology [colorectal primary (HR=1.41) and HER2(-) breast primary (HR=1.6), each relative to other histologies]. Trends for HER2(+) breast primary predicting for favorable WBRT-free survival (HR 0.82) and melanoma for shortened WBRT-free survival (HR=1.1) were noted. The nomogram developed estimates probabilities of 6- and 12-mo WBRT-free survival based on coefficients from the aforementioned regression model with Harrell’s C concordance statistic of 0.62. The table below displays nomogram output for 3 sample cases.Poster Viewing Abstracts 2193; Table 1CaseAgeHistology# of brain metastasesCNS symptomsExtracranial disease statusExtracranial disease burden6-mo probability of WBRT-free survival12-mo probability of WBRT-free survival150HER2(+) breast1AbsentStableNone>80%>70%260NSCLC3PresentStableOligometastatic55%35%370Colorectal5PresentProgressiveWidespread<20%<5% Open table in a new tab Appropriate patient selection for upfront SRS alone has important quality of life and cost implications. Our nomogram can be used to optimize management decisions by providing individual prediction of a novel and clinically useful endpoint, WBRT-free survival." @default.
• W2273890916 created "2016-06-24" @default.
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• W2273890916 date "2015-11-01" @default.
• W2273890916 modified "2023-09-28" @default.
• W2273890916 title "Multi-institutional Nomogram Predicting Survival Free From Salvage Whole-Brain Radiation After Radiosurgery for Brain Metastases" @default.
• W2273890916 doi "https://doi.org/10.1016/j.ijrobp.2015.07.740" @default.
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