Abstract
Many patients with few cerebral metastases receive radiosurgery alone. The goal of this study was to create a tool to estimate the survival of such patients. To identify characteristics associated with survival, nine variables including radiosurgery dose, age, gender, Eastern cooperative oncology group performance score (ECOG-PS), primary tumor type, number/size of cerebral metastases, location of cerebral metastases, extra-cerebral metastases and time between cancer diagnosis and radiosurgery were analyzed in 214 patients. On multivariate analysis, age (p=0.03), ECOG-PS (p=0.02) and extra-cerebral metastases (p<0.01) had significant impacts on survival. Scoring points for each patient were obtained from 12-month survival rates (in %) related to the significant variables divided by 10. Addition of the scoring points of the three variables resulted in a patient's total predictive score. Two groups were designed, A (10-14 points) and B (16-17 points). Twelve-month survival rates were 33% and 77%, respectively (p<0.001). Median survival times were 8 and 20 months, respectively. Because most patients of group A died from extra-cerebral disease and/or new cerebral lesions, early systemic treatment and additional WBI should be considered. As cause of death in group B was mostly new cerebral metastases, additional WBI appears even more important for this group.
Highlights
Many patients presenting with very few metastatic lesions within the brain receive radiosurgery, which is a non-invasive and effective treatment with only mild toxicity (Hyun et al, 2013; Duan et al, 2014)
To identify characteristics associated with survival, nine variables including radiosurgery dose, age, gender, Eastern cooperative oncology group performance score (ECOG-PS), primary tumor type, number/size of cerebral metastases, location of cerebral metastases, extra-cerebral metastases and time between cancer diagnosis and radiosurgery were analyzed in 214 patients
In the additional multivariate analysis, age (risk ratio [RR] 1.46; 95%-confidence interval (CI) 1.04-2.06; p=0.03), ECOG-PS (RR 1.57; 95%-CI 1.10-2.23; p=0.02), and extra-cerebral metastases (RR 1.63; 95%-CI 1.15-2.33; p
Summary
Many patients presenting with very few metastatic lesions within the brain receive radiosurgery, which is a non-invasive and effective treatment with only mild toxicity (Hyun et al, 2013; Duan et al, 2014). In order to treat patients with brain metastases appropriately, personalized treatment approaches are required Such a personalized approach can only be regarded optimal, if the survival prognosis of the corresponding patients can be predicted as precisely as possible. In 2004, the basic score for brain metastases (BSBM) was presented (Lorenzoni et al, 2004) This tool was developed in 110 patients treated with Leksell Gamma Knife (cobalt 60) radiosurgery alone. The third tool, a subclassification of recursive partitioning analysis (RPA) class 2 patients was published on 2012 (Yamamoto et al, 2012). It was created from a large series of patients who had received Gamma Knife (cobalt 60) radiosurgery alone
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