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Acta Oncol. 2018 Feb;57(2):226-230. doi: 10.1080/0284186X.2017.1385842. Epub 2017 Oct 14.

A prediction model for early death in non-small cell lung cancer patients following curative-intent chemoradiotherapy.

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a Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology , Maastricht University Medical Centre , Maastricht , The Netherlands.
b Department of Radiation Oncology , University of Michigan , Ann Arbor , MI , USA.
c The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust , Manchester , UK.
d Cancer Therapy Centre, Liverpool Hospital , Liverpool , NSW , Australia.
e Institute of Medical Physics, School of Physics , University of Sydney , Sydney , NSW , Australia.



Early death after a treatment can be seen as a therapeutic failure. Accurate prediction of patients at risk for early mortality is crucial to avoid unnecessary harm and reducing costs. The goal of our work is two-fold: first, to evaluate the performance of a previously published model for early death in our cohorts. Second, to develop a prognostic model for early death prediction following radiotherapy.


Patients with NSCLC treated with chemoradiotherapy or radiotherapy alone were included in this study. Four different cohorts from different countries were available for this work (N = 1540). The previous model used age, gender, performance status, tumor stage, income deprivation, no previous treatment given (yes/no) and body mass index to make predictions. A random forest model was developed by learning on the Maastro cohort (N = 698). The new model used performance status, age, gender, T and N stage, total tumor volume (cc), total tumor dose (Gy) and chemotherapy timing (none, sequential, concurrent) to make predictions. Death within 4 months of receiving the first radiotherapy fraction was used as the outcome.


Early death rates ranged from 6 to 11% within the four cohorts. The previous model performed with AUC values ranging from 0.54 to 0.64 on the validation cohorts. Our newly developed model had improved AUC values ranging from 0.62 to 0.71 on the validation cohorts.


Using advanced machine learning methods and informative variables, prognostic models for early mortality can be developed. Development of accurate prognostic tools for early mortality is important to inform patients about treatment options and optimize care.

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