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. 2014 Sep;16(9):1283-8.
doi: 10.1093/neuonc/nou018. Epub 2014 Feb 20.

A nomogram for predicting distant brain failure in patients treated with gamma knife stereotactic radiosurgery without whole brain radiotherapy

Diandra N Ayala-Peacock  1 , Ann M Peiffer  1 , John T Lucas  1 , Scott Isom  1 , J Griff Kuremsky  1 , James J Urbanic  1 , J Daniel Bourland  1 , Adrian W Laxton  1 , Stephen B Tatter  1 , Edward G Shaw  1 , Michael D Chan  1
Affiliations

A nomogram for predicting distant brain failure in patients treated with gamma knife stereotactic radiosurgery without whole brain radiotherapy

Diandra N Ayala-Peacock et al. Neuro Oncol. 2014 Sep.

Abstract

Background: We review our single institution experience to determine predictive factors for early and delayed distant brain failure (DBF) after radiosurgery without whole brain radiotherapy (WBRT) for brain metastases.

Materials and methods: Between January 2000 and December 2010, a total of 464 patients were treated with Gamma Knife stereotactic radiosurgery (SRS) without WBRT for primary management of newly diagnosed brain metastases. Histology, systemic disease, RPA class, and number of metastases were evaluated as possible predictors of DBF rate. DBF rates were determined by serial MRI. Kaplan-Meier method was used to estimate rate of DBF. Multivariate analysis was performed using Cox Proportional Hazard regression.

Results: Median number of lesions treated was 1 (range 1-13). Median time to DBF was 4.9 months. Twenty-seven percent of patients ultimately required WBRT with median time to WBRT of 5.6 months. Progressive systemic disease (χ(2)= 16.748, P < .001), number of metastases at SRS (χ(2) = 27.216, P < .001), discovery of new metastases at time of SRS (χ(2) = 9.197, P < .01), and histology (χ(2) = 12.819, P < .07) were factors that predicted for earlier time to distant failure. High risk histologic subtypes (melanoma, her2 negative breast, χ(2) = 11.020, P < .001) and low risk subtypes (her2 + breast, χ(2) = 11.343, P < .001) were identified. Progressive systemic disease (χ(2) = 9.549, P < .01), number of brain metastases (χ(2) = 16.953, P < .001), minimum SRS dose (χ(2) = 21.609, P < .001), and widespread metastatic disease (χ(2) = 29.396, P < .001) were predictive of shorter time to WBRT.

Conclusion: Systemic disease, number of metastases, and histology are factors that predict distant failure rate after primary radiosurgical management of brain metastases.

Keywords: brain metastases; distant brain failure; nomogram; stereotactic radiosurgery.

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Figures

Fig. 1.
Fig. 1.
Kaplan–Meier plot of freedom from DBF (Fig. 1a) and freedom from LF (Fig. 1b) for 464 patients treated with upfront radiosurgery without whole brain radiotherapy.
Fig. 2.
Fig. 2.
Kaplan–Meier plot of freedom from DBF stratified by risk stratification groupings. Her2+ breast cancer represented the lowest risk group. Melanoma and Her2 negative breast cancer represented the highest risk group. All other histologies were included in the intermediate risk group.
Fig. 3.
Fig. 3.
Kaplan–Meier plot of freedom from whole brain radiotherapy.
Fig. 4.
Fig. 4.
Kaplan–Meier plot of freedom from whole brain radiotherapy by risk stratification groupings.
Fig. 5.
Fig. 5.
Nomogram for distant brain failure at 6 and 9 months. Systemic Disease Status 3 = Unknown, 2 = Stable, 1 = Progressive. Abbreviations: Met num, Metastasis Number; Systemic Disease GK0, Disease status at the time of Gamma Knife; L Squamous, Lung Squamous Cell Carcinoma; L Adeno, Lung Adenocarcinoma; Her2, Human Epidermal Growth Factor Receptor 2; RCC, Renal Cell Carcinoma; L Other, Lung Other histology; NSCLC, Non-Small Cell Lung Cancer.
Fig. 6.
Fig. 6.
Calibration Curves for (a) three, (b) six, and (c) nine months.
See this image and copyright information in PMC

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