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. 2023 Apr 12;12(4):585.
doi: 10.3390/biology12040585.

The First Survival Score for Patients Treated with Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost for Brain Metastases

Dirk Rades  1 , Leonie Johannwerner  1 , Elisa M Werner  1 , Florian Cremers  1 , Nathan Y Yu  2
Affiliations

The First Survival Score for Patients Treated with Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost for Brain Metastases

Dirk Rades et al. Biology (Basel). .

Abstract

A modern approach for brain metastases includes whole-brain radiotherapy plus simultaneous boost (WBRT+SIB). We developed a survival score in 128 patients treated with WBRT+SIB. Three models, each including three prognostic groups, were created. Positive predictive values (PPVs) for death ≤6 and survival ≥6 months were calculated. On multivariate analyses, performance score (KPS) and the number of brain metastases were significantly associated with survival. On univariate analyses, age showed a strong trend, and extra-cerebral cranial metastases a trend. In Model 1 (KPS, number of lesions), compared groups had 6-month survival rates of 15%, 38% and 57%. In Model 2 (KPS, lesions, age), rates were 17%, 33% and 75%, and in Model 3 (KPS, lesions, age, extra-cerebral metastases), 14%, 34% and 78%. PPVs for death ≤6 and survival ≥6 months were 85% and 57% (Model 1), 83% and 75% (Model 2), and 86% and 78% (Model 3). Thus, all models were accurate in predicting death ≤ 6 months; poor-prognosis patients may not benefit from SIB. Models 2 and 3 were superior in predicting survival ≥ 6 months. Given that Model 3 requires more data (including extensive staging), Model 2 is considered favorable for many patients. If extra-cerebral metastases are already known or extensive staging has been performed, Model 3 can also be used.

Keywords: cerebral metastases; predictive model; simultaneous integrated boost; survival; whole-brain radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest related to this study.

Figures

Figure 1
Figure 1
Example of a treatment plan of whole-brain radiotherapy plus a simultaneous integrated boost to the metastatic lesions using a hippocampus-sparing technique (Department of Radiation Oncology, University of Lübeck, Germany).
Figure 2
Figure 2
Model 1 (including KPS and number of lesions): Six-month survival rates of patient scores ranging between 5 and 9 points.
Figure 3
Figure 3
Model 2 (including KPS, number of lesions, and age): Six-month survival rates of patient scores ranging between 8 and 13 points.
Figure 4
Figure 4
Model 3 (including KPS, number of lesions, age, and extra-cerebral metastases): Six-month survival rates of patient scores ranging between 11 and 17 points.
Figure 5
Figure 5
Model 1: Kaplan-Meier curves for the survival of the three groups (5, 6–8 and 9 points).
Figure 6
Figure 6
Model 2: Kaplan-Meier curves for survival of the three groups (8, 9–12, and 13 points).
Figure 7
Figure 7
Model 3: Kaplan-Meier curves for survival of the three groups (11, 12–16 and 17 points).
See this image and copyright information in PMC

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