Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study

David J Carpenter¹, Brahma Natarajan², Muzamil Arshad³, Divya Natesan⁴, Olivia Schultz³, Michael J Moravan⁵, Charlotte Read^{1

6}, Kyle J Lafata^{1

6

7}, Will Giles¹, Peter Fecci⁸, Trey C Mullikin¹, Zachary J Reitman¹, John P Kirkpatrick^{1

8}, Scott R Floyd¹, Steven J Chmura³, Julian C Hong^{9

10

11}, Joseph K Salama^{1

12}

Affiliations

¹ Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
² Department of Medicine, University of Carolina Chapel Hill, Chapel Hill, NC 27599, USA.
³ Department of Radiation Oncology, University of Chicago, Chicago, IL 60637, USA.
⁴ Department of Radiation Oncology, University of Carolina Chapel Hill, Chapel Hill, NC 27599, USA.
⁵ Radiation Oncology Clinical Service, Veterans Affairs St. Louis Health Care System, St. Louis, MO 63110, USA.
⁶ Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
⁷ Department of Electrical and Computer Engineering, Duke University, Durham, NC 27710, USA.
⁸ Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
⁹ Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA.
¹⁰ Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA 94143, USA.
¹¹ Joint Program in Computational Precision Health, University of California San Francisco, San Francisco, CA 94143, USA, University of California Berkeley, Berkeley, CA 94720, USA.
¹² Radiation Oncology Clinical Service, Durham VA Health Care System, Durham, NC 27710, USA.

PMID: 36358606
PMCID: PMC9657742
DOI: 10.3390/cancers14215186

Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study

David J Carpenter et al. Cancers (Basel). 2022.

. 2022 Oct 22;14(21):5186.

doi: 10.3390/cancers14215186.

Authors

Affiliations

¹ Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
² Department of Medicine, University of Carolina Chapel Hill, Chapel Hill, NC 27599, USA.
³ Department of Radiation Oncology, University of Chicago, Chicago, IL 60637, USA.
⁴ Department of Radiation Oncology, University of Carolina Chapel Hill, Chapel Hill, NC 27599, USA.
⁵ Radiation Oncology Clinical Service, Veterans Affairs St. Louis Health Care System, St. Louis, MO 63110, USA.
⁶ Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
⁷ Department of Electrical and Computer Engineering, Duke University, Durham, NC 27710, USA.
⁸ Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
⁹ Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA.
¹⁰ Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA 94143, USA.
¹¹ Joint Program in Computational Precision Health, University of California San Francisco, San Francisco, CA 94143, USA, University of California Berkeley, Berkeley, CA 94720, USA.
¹² Radiation Oncology Clinical Service, Durham VA Health Care System, Durham, NC 27710, USA.

PMID: 36358606
PMCID: PMC9657742
DOI: 10.3390/cancers14215186

Abstract

Stereotactic radiosurgery (SRS) is a standard of care for many patients with brain metastases. To optimize post-SRS surveillance, this study aimed to validate a previously published nomogram predicting post-SRS intracranial progression (IP). We identified consecutive patients completing an initial course of SRS across two institutions between July 2017 and December 2020. Patients were classified as low- or high-risk for post-SRS IP per a previously published nomogram. Overall survival (OS) and freedom from IP (FFIP) were assessed via the Kaplan−Meier method. Assessment of parameters impacting FFIP was performed with univariable and multivariable Cox proportional hazard models. Among 890 patients, median follow-up was 9.8 months (95% CI 9.1−11.2 months). In total, 47% had NSCLC primary tumors, and 47% had oligometastatic disease (defined as ≤5 metastastic foci) at the time of SRS. Per the IP nomogram, 53% of patients were deemed high-risk. For low- and high-risk patients, median FFIP was 13.9 months (95% CI 11.1−17.1 months) and 7.6 months (95% CI 6.4−9.3 months), respectively, and FFIP was superior in low-risk patients (p < 0.0001). This large multisite BM cohort supports the use of an IP nomogram as a quick and simple means of stratifying patients into low- and high-risk groups for post-SRS IP.

Keywords: brain metastases; intracranial progression; stereotactic radiosurgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Overall survival following stereotactic radiosurgery is shown for all patients with 95% confidence intervals (A) and by intracranial progression nomogram classification (B). Abbreviation: SRS, stereotactic radiosurgery.

**Figure 2**
Freedom from intracranial progression (IP) is shown for all patients per IP nomogram risk stratification. Abbreviation: SRS, stereotactic radiosurgery.

See this image and copyright information in PMC

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Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study

Affiliations

Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources