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• W2523814348 abstract "In this study, we attempt to better discern the factors predictive of distant brain failure (DBF) and determine for which patients initial whole brain radiotherapy (WBRT) may reasonably be deferred. A total of 2,941 patients from eight academic centers were initially treated with upfront SRS alone for brain metastasis. Competing risks analysis was performed to estimate the cumulative incidence of DBF versus death prior to DBF, as well as the cumulative incidence of first salvage with SRS versus WBRT versus death prior to salvage. Univariate and multivariate analysis were performed to estimate subdistribution hazard ratios (HRs) for predictor variables of interest. Of the 2,941 patients treated with upfront SRS alone, 2441 (83.0%) patients were deceased at the time of analysis, with DBF occurring in 1358 (46.5%) of all patients. Median overall survival (OS) was 9.8 months (95% CI = 9.2-10.3 months). The estimated cumulative incidences of DBF at 6, 12, and 24 months were 27.2%, 35.7%, and 45.1%, respectively. Predictors of DBF identified on univariate analysis included age (P < 0.001), KPS (P < 0.001), systemic disease status (P < 0.001), number of brain metastases (P < 0.001), SRS dose (P < 0.001), and melanoma histology (P < 0.001). Multivariate analysis (MVA) identified an increased hazard of DBF associated with increasing number of brain metastases (HR = 1.08, P < 0.001) and melanoma histology (HR = 1.31, P < 0.001), while there was a decreased hazard of DBF (and an increased hazard of death prior to DBF) associated with age >60 (HR = 0.82, P < 0.001), KPS <70 (HR = 0.54, P < 0.001), progressive systemic disease (HR = 0.86, P = 0.003), and SRS dose <20 Gy (HR = 0.79, P < 0.001). MVA for SRS vs. WBRT vs. death prior to salvage revealed an increased hazard of first salvage WBRT seen with increasing number of brain metastases (P < 0.001), which was most significant when using a cut-point of >8 vs ≤8 brain metastases (HR = 3.09, P < 0.001). For patients with >8 brain metastases, the 9-month cumulative incidence of first salvage WBRT was 25.7% (SRS: 10.0%) versus 9.1% (SRS: 14.3%) for ≤8 brain metastases. Predictors of DBF included an increased number of brain metastases and melanoma histology, while age >60, KPS <70, progressive systemic disease, and initial SRS dose <20 Gy were predictive of increased risk of death prior to DBF/WBRT. Patients with ≤8 brain metastases were less likely to need WBRT salvage following initial DBF, while those with >8 brain metastases had a higher incidence of initial salvage with WBRT than with SRS. Initial deferral of WBRT therefore appears reasonable for patients with ≤8 brain metastases, while it may be worthwhile to consider WBRT for patients with >8 brain metastases provided the aforementioned features predictive of death prior to DBF (particularly KPS <70) are not present." @default.
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• W2523814348 date "2016-10-01" @default.
• W2523814348 modified "2023-09-28" @default.
• W2523814348 title "Multi-Institutional Competing Risks Analysis Predicting Distant Brain Failure and Salvage Patterns After Upfront Radiosurgery Without Whole-Brain Radiation Therapy for Brain Metastasis" @default.
• W2523814348 doi "https://doi.org/10.1016/j.ijrobp.2016.06.452" @default.
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