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 »
- Authors:
-
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
- Department of Medicine - Hematology & Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)
- 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
- Journal Name:
- International Journal of Radiation Oncology, Biology and Physics
- Additional Journal Information:
- 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); Journal ID: ISSN 0360-3016
- 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, 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, 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. https://doi.org/10.1016/J.IJROBP.2017.01.201
Farris, Michael, 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. 2017.
"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. https://doi.org/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 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},
url = {https://www.osti.gov/biblio/22649916},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
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}
}