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Title: Brain Metastasis Velocity: A Novel Prognostic Metric Predictive of Overall Survival and Freedom From Whole-Brain Radiation Therapy After Distant Brain Failure Following Upfront Radiosurgery Alone

Abstract

Purpose: Prior statistical models attempted to identify risk factors for time to distant brain failure (DBF) or time to salvage whole-brain radiation therapy (WBRT) to predict the benefit of early WBRT versus stereotactic radiosurgery (SRS) alone. We introduce a novel clinical metric, brain metastasis velocity (BMV), for predicting clinical outcomes after initial DBF following upfront SRS alone. Methods and Materials: BMV was defined as the cumulative number of new brain metastases that developed over time since first SRS in years. Patients were classified by BMV into low-, intermediate-, and high-risk groups, consisting of <4, 4 to 13, and >13 new metastases per year, respectively. Histology, number of metastases at the time of first SRS, and systemic disease status were assessed for effect on BMV. Results: Of 737 patients treated at our institution with upfront SRS without WBRT, 286 had ≥1 DBF event. A lower BMV predicted for improved overall survival (OS) following initial DBF (log-rank P<.0001). Median OS for the low, intermediate, and high BMV groups was 12.4 months (95% confidence interval [CI], 10.4-16.9 months), 8.2 months (95% CI, 5.0-9.7 months), and 4.3 months (95% CI, 2.6-6.7 months), respectively. Multivariate analysis showed that BMV remained the dominant predictor of OS, with a hazard ratio of 2.75 formore » the high BMV group (95% CI, 1.94-3.89; P<.0001) and a hazard ratio of 1.65 for the intermediate BMV group (95% CI, 1.18-2.30; P<.004). A lower BMV was associated with decreased rates of salvage WBRT (P=.02) and neurologic death (P=.008). Factors predictive for a higher BMV included ≥2 initial brain metastases (P=.004) and melanoma histology (P=.008). Conclusions: BMV is a novel metric associated with OS, neurologic death, and need for salvage WBRT after initial DBF following upfront SRS alone.« less

Authors:
 [1]; ; ; ; ; ;  [1];  [2];  [3]; ;  [4];  [5];  [1]
  1. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
  2. Department of Medicine - Hematology & Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
  3. Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
  4. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
  5. Center for Bioinformatics & Systems Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
Publication Date:
OSTI Identifier:
22649916
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 98; Journal Issue: 1; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; METRICS; MULTIVARIATE ANALYSIS; NEOPLASMS; RADIOTHERAPY; STATISTICAL MODELS; SURGERY; SURVIVAL TIME

Citation Formats

Farris, Michael, E-mail: mfarris@wakehealth.edu, McTyre, Emory R., Cramer, Christina K., Hughes, Ryan, Randolph, David M., Ayala-Peacock, Diandra N., Bourland, J. Daniel, Ruiz, Jimmy, Watabe, Kounosuke, Laxton, Adrian W., Tatter, Stephen B., Zhou, Xiaobo, and Chan, Michael D. Brain Metastasis Velocity: A Novel Prognostic Metric Predictive of Overall Survival and Freedom From Whole-Brain Radiation Therapy After Distant Brain Failure Following Upfront Radiosurgery Alone. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.01.201.
Farris, Michael, E-mail: mfarris@wakehealth.edu, McTyre, Emory R., Cramer, Christina K., Hughes, Ryan, Randolph, David M., Ayala-Peacock, Diandra N., Bourland, J. Daniel, Ruiz, Jimmy, Watabe, Kounosuke, Laxton, Adrian W., Tatter, Stephen B., Zhou, Xiaobo, & Chan, Michael D. Brain Metastasis Velocity: A Novel Prognostic Metric Predictive of Overall Survival and Freedom From Whole-Brain Radiation Therapy After Distant Brain Failure Following Upfront Radiosurgery Alone. United States. doi:10.1016/J.IJROBP.2017.01.201.
Farris, Michael, E-mail: mfarris@wakehealth.edu, McTyre, Emory R., Cramer, Christina K., Hughes, Ryan, Randolph, David M., Ayala-Peacock, Diandra N., Bourland, J. Daniel, Ruiz, Jimmy, Watabe, Kounosuke, Laxton, Adrian W., Tatter, Stephen B., Zhou, Xiaobo, and Chan, Michael D. Mon . "Brain Metastasis Velocity: A Novel Prognostic Metric Predictive of Overall Survival and Freedom From Whole-Brain Radiation Therapy After Distant Brain Failure Following Upfront Radiosurgery Alone". United States. doi:10.1016/J.IJROBP.2017.01.201.
@article{osti_22649916,
title = {Brain Metastasis Velocity: A Novel Prognostic Metric Predictive of Overall Survival and Freedom From Whole-Brain Radiation Therapy After Distant Brain Failure Following Upfront Radiosurgery Alone},
author = {Farris, Michael, E-mail: mfarris@wakehealth.edu and McTyre, Emory R. and Cramer, Christina K. and Hughes, Ryan and Randolph, David M. and Ayala-Peacock, Diandra N. and Bourland, J. Daniel and Ruiz, Jimmy and Watabe, Kounosuke and Laxton, Adrian W. and Tatter, Stephen B. and Zhou, Xiaobo and Chan, Michael D.},
abstractNote = {Purpose: Prior statistical models attempted to identify risk factors for time to distant brain failure (DBF) or time to salvage whole-brain radiation therapy (WBRT) to predict the benefit of early WBRT versus stereotactic radiosurgery (SRS) alone. We introduce a novel clinical metric, brain metastasis velocity (BMV), for predicting clinical outcomes after initial DBF following upfront SRS alone. Methods and Materials: BMV was defined as the cumulative number of new brain metastases that developed over time since first SRS in years. Patients were classified by BMV into low-, intermediate-, and high-risk groups, consisting of <4, 4 to 13, and >13 new metastases per year, respectively. Histology, number of metastases at the time of first SRS, and systemic disease status were assessed for effect on BMV. Results: Of 737 patients treated at our institution with upfront SRS without WBRT, 286 had ≥1 DBF event. A lower BMV predicted for improved overall survival (OS) following initial DBF (log-rank P<.0001). Median OS for the low, intermediate, and high BMV groups was 12.4 months (95% confidence interval [CI], 10.4-16.9 months), 8.2 months (95% CI, 5.0-9.7 months), and 4.3 months (95% CI, 2.6-6.7 months), respectively. Multivariate analysis showed that BMV remained the dominant predictor of OS, with a hazard ratio of 2.75 for the high BMV group (95% CI, 1.94-3.89; P<.0001) and a hazard ratio of 1.65 for the intermediate BMV group (95% CI, 1.18-2.30; P<.004). A lower BMV was associated with decreased rates of salvage WBRT (P=.02) and neurologic death (P=.008). Factors predictive for a higher BMV included ≥2 initial brain metastases (P=.004) and melanoma histology (P=.008). Conclusions: BMV is a novel metric associated with OS, neurologic death, and need for salvage WBRT after initial DBF following upfront SRS alone.},
doi = {10.1016/J.IJROBP.2017.01.201},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 98,
place = {United States},
year = {Mon May 01 00:00:00 EDT 2017},
month = {Mon May 01 00:00:00 EDT 2017}
}