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Radiother Oncol. 2017 May;123(2):189-194. doi: 10.1016/j.radonc.2017.02.006. Epub 2017 Feb 23.

Individualized early death and long-term survival prediction after stereotactic radiosurgery for brain metastases of non-small cell lung cancer: Two externally validated nomograms.

Author information

1
Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands. Electronic address: jaap.zindler@maastro.nl.
2
Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands.
3
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
4
Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands; Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Germany.
5
Department of Radiation Oncology, Catharina Hospital Eindhoven, The Netherlands.
6
Department of Radiation Oncology, Verbeeten Institute, Tilburg, The Netherlands.

Abstract

INTRODUCTION:

Commonly used clinical models for survival prediction after stereotactic radiosurgery (SRS) for brain metastases (BMs) are limited by the lack of individual risk scores and disproportionate prognostic groups. In this study, two nomograms were developed to overcome these limitations.

METHODS:

495 patients with BMs of NSCLC treated with SRS for a limited number of BMs in four Dutch radiation oncology centers were identified and divided in a training cohort (n=214, patients treated in one hospital) and an external validation cohort n=281, patients treated in three other hospitals). Using the training cohort, nomograms were developed for prediction of early death (<3months) and long-term survival (>12months) with prognostic factors for survival. Accuracy of prediction was defined as the area under the curve (AUC) by receiver operating characteristics analysis for prediction of early death and long term survival. The accuracy of the nomograms was also tested in the external validation cohort.

RESULTS:

Prognostic factors for survival were: WHO performance status, presence of extracranial metastases, age, GTV largest BM, and gender. Number of brain metastases and primary tumor control were not prognostic factors for survival. In the external validation cohort, the nomogram predicted early death statistically significantly better (p<0.05) than the unfavorable groups of the RPA, DS-GPA, GGS, SIR, and Rades 2015 (AUC=0.70 versus range AUCs=0.51-0.60 respectively). With an AUC of 0.67, the other nomogram predicted 1year survival statistically significantly better (p<0.05) than the favorable groups of four models (range AUCs=0.57-0.61), except for the SIR (AUC=0.64, p=0.34). The models are available on www.predictcancer.org.

CONCLUSION:

The nomograms predicted early death and long-term survival more accurately than commonly used prognostic scores after SRS for a limited number of BMs of NSCLC. Moreover these nomograms enable individualized probability assessment and are easy into use in routine clinical practice.

KEYWORDS:

Individualized brain metastases; Prognostic models; Stereotactic radiosurgery

PMID:
28237400
DOI:
10.1016/j.radonc.2017.02.006
[Indexed for MEDLINE]

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