Abstract
The study aimed to analyze potential prognostic factors in patients treated with robotic radiosurgery for brain metastases irrespective of primary tumor location and create a simple prognostic score that can be used without a full diagnostic workup. A retrospective analysis of 142 patients with 1–9 brain metastases treated with stereotactic radiosurgery (1–4 fractions) was performed. Volumes of all lesions were calculated using linear dimensions of the tumors (CC, LR, AP) and 4/3*π*(CC/2)*(LR/2)*(AP/2) formula. Kaplan–Meier method and log-rank test were used to analyze survival. Variables significantly associated with overall survival in univariate analysis were included in Cox multivariate analysis. The validity of the model was tested with the bootstrap method. Variables from the final model were used to construct a new prognostic index by assigning points according to the impact of a specific variable on overall survival. In the multivariate analysis, four factors: Karnofsky Performance Status (p = 0.000068), number of brain metastases (p = 0.019), volume of the largest lesion (p = 0.0037), and presence of extracerebral metastases (p = 0.0017), were independent predictors of survival. Total scores ranged from 0 to 12 points, and patients were divided into four groups based on median survival of each subgroup: 0–1 points—18.8 months, 2–3 points—16.9 months, 4–5 points—5.6 months, and ≥ 6 points—4.9 months (p < 0.001). The new prognostic index is simple to calculate. It has a strong prognostic value in a heterogeneous population of patients with a various number of brain metastases, but its value requires confirmation in another cohort.
Highlights
The study aimed to analyze potential prognostic factors in patients treated with robotic radiosurgery for brain metastases irrespective of primary tumor location and create a simple prognostic score that can be used without a full diagnostic workup
≤ 6 months a) Recursive Partitioning Analysis (RPA), Basic Score for Brain Metastases (BSBM) and Grading System (GGS) do not take the number of brain metastases into account, whereas this parameter has an established prognostic value, b) RPA, Score Index for Radiosurgery (SIR) and BSBM require the assessment of systemic disease status, which may be difficult to achieve before the introduction of Brain metastases (BMs) treatment, c) SIR requires a volume of the largest BM, which is usually available after a decision concerning treatment was made and requires time-consuming contouring, d) ds-Graded Prognostic Assessment (GPA) requires detailed diagnostics with complex pathological tests, not always available at the time of clinical decision making
The SIR, BSBM and GGS were initially designed for patients undergoing stereotactic radiosurgery, whereas others (GPA, Diagnosis-specific Graded Prognostic Assessment (ds-GPA) and Rades score) were constructed based on the analysis of patients treated with various regimens
Summary
The study aimed to analyze potential prognostic factors in patients treated with robotic radiosurgery for brain metastases irrespective of primary tumor location and create a simple prognostic score that can be used without a full diagnostic workup. The SIR, BSBM and GGS were initially designed for patients undergoing stereotactic radiosurgery, whereas others (GPA, ds-GPA and Rades score) were constructed based on the analysis of patients treated with various regimens (surgery, WBRT or SRS). The objective of this study was to identify independent pretreatment factors associated with overall survival and create an easy-to-use prognostic score for patients with brain metastases irrespective of primary tumor location and for those without full diagnostic workup. We aimed to validate previously described stratification systems in the Polish population of patients with brain metastases
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