| Title |
Prediction of new brain metastases after radiosurgery: validation and analysis of performance of a multi-institutional nomogram
|
|---|---|
| Published in |
Journal of Neuro-Oncology, August 2017
|
| DOI | 10.1007/s11060-017-2588-4 |
| Pubmed ID | |
| Authors |
Diandra N. Ayala-Peacock, Albert Attia, Steve E. Braunstein, Manmeet S. Ahluwalia, Jaroslaw Hepel, Caroline Chung, Joseph Contessa, Emory McTyre, Ann M. Peiffer, John T. Lucas, Scott Isom, Nicholas M. Pajewski, Rupesh Kotecha, Mark J. Stavas, Brandi R. Page, Lawrence Kleinberg, Colette Shen, Robert B. Taylor, Nasarachi E. Onyeuku, Andrew T. Hyde, Daniel Gorovets, Samuel T. Chao, Christopher Corso, Jimmy Ruiz, Kounosuke Watabe, Stephen B. Tatter, Gelareh Zadeh, Veronica L. S. Chiang, John B. Fiveash, Michael D. Chan |
| Abstract |
Stereotactic radiosurgery (SRS) without whole brain radiotherapy (WBRT) for brain metastases can avoid WBRT toxicities, but with risk of subsequent distant brain failure (DBF). Sole use of number of metastases to triage patients may be an unrefined method. Data on 1354 patients treated with SRS monotherapy from 2000 to 2013 for new brain metastases was collected across eight academic centers. The cohort was divided into training and validation datasets and a prognostic model was developed for time to DBF. We then evaluated the discrimination and calibration of the model within the validation dataset, and confirmed its performance with an independent contemporary cohort. Number of metastases (≥8, HR 3.53 p = 0.0001), minimum margin dose (HR 1.07 p = 0.0033), and melanoma histology (HR 1.45, p = 0.0187) were associated with DBF. A prognostic index derived from the training dataset exhibited ability to discriminate patients' DBF risk within the validation dataset (c-index = 0.631) and Heller's explained relative risk (HERR) = 0.173 (SE = 0.048). Absolute number of metastases was evaluated for its ability to predict DBF in the derivation and validation datasets, and was inferior to the nomogram. A nomogram high-risk threshold yielding a 2.1-fold increased need for early WBRT was identified. Nomogram values also correlated to number of brain metastases at time of failure (r = 0.38, p < 0.0001). We present a multi-institutionally validated prognostic model and nomogram to predict risk of DBF and guide risk-stratification of patients who are appropriate candidates for radiosurgery versus upfront WBRT. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Portugal | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 35 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 35 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 3 | 9% |
| Student > Ph. D. Student | 3 | 9% |
| Researcher | 3 | 9% |
| Student > Postgraduate | 3 | 9% |
| Student > Bachelor | 2 | 6% |
| Other | 7 | 20% |
| Unknown | 14 | 40% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 7 | 20% |
| Neuroscience | 5 | 14% |
| Biochemistry, Genetics and Molecular Biology | 2 | 6% |
| Social Sciences | 2 | 6% |
| Computer Science | 1 | 3% |
| Other | 2 | 6% |
| Unknown | 16 | 46% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 August 2017.
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#15,687,628
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Outputs from Journal of Neuro-Oncology
#1,995
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#200,114
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Outputs of similar age from Journal of Neuro-Oncology
#24
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