Brain Metastasis Growth Kinetics: A Novel Prognosticator for Stereotactic Radiotherapy |
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| Institution: | 1. Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong;2. Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore;3. Department of Radiology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong;4. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong;5. Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong;1. The Institute of Cancer Research, London, UK;2. Head and Neck Unit, The Royal Marsden, London, UK;3. Leeds Cancer Centre, St James’s Institute of Oncology, Leeds Teaching Hospital NHS Trust, Leeds, UK;4. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK;5. Division of Cancer Sciences, The University of Manchester, Manchester, UK;1. Leeds Institute of Medical Research at St James''s, University of Leeds, Leeds, UK;2. Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK;3. Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK;4. Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK;5. The Christie NHS Foundation Trust, Manchester, UK;7. The Royal Marsden Hospital, Sutton, UK;11. Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK;12. Institute of Cancer Sciences, University of Glasgow, Glasgow, UK;8. Beatson West of Scotland Cancer Centre, Glasgow, UK;9. Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, UK;71. The University of Liverpool, Liverpool, UK;1. Northern Ireland Cancer Centre, Belfast, United Kingdom;2. University College London Hospitals NHS Foundation Trust, London, United Kingdom;3. The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom;4. The Institute of Cancer Research, London, United Kingdom;5. Radiotherapy Trials Quality Assurance (RTTQA) Group, Northwood, United Kingdom;1. Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK;2. University Hospitals Sussex NHS Foundation Trust, West Sussex, UK;1. The Royal Marsden NHS Foundation Trust, London, UK;2. UKRI Centre for Doctoral Training in Artificial Intelligence in Healthcare, Imperial College London, London, UK |
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| Abstract: | AimsThe rate of size change in brain metastasis may have clinical implications on tumour biology and prognosis for patients who receive stereotactic radiotherapy (SRT). We analysed the prognostic value of brain metastasis size kinetics and propose a model for patients with brain metastases treated with linac-based SRT in predicting overall survival.Materials and methodsWe analysed the patients receiving linac-based SRT between 2010 and 2020. Patient and oncological factors, including the changes in sizes of brain metastasis between the diagnostic and stereotactic magnetic resonance imaging, were collected. The associations between prognostic factors and overall survival were assessed using Cox regression with least absolute selection and shrinkage operator (LASSO) checked by 500 bootstrap replications. Our prognostic score was calculated by evaluating the most statistically significant factors. Patients were grouped and compared according to our proposed score, Score Index for Radiosurgery in Brain Metastases (SIR) and Basic Score for Brain Metastases (BS-BM).ResultsIn total, 85 patients were included. We developed the prognostic model based on the most important predictors of overall survival: growth kinetics, i.e. percentage change in brain metastasis size per day between the diagnostic and stereotactic magnetic resonance imaging (hazard ratio per 1% increase, 1.32; 95% confidence interval 1.06–1.65), extracranial oligometastatic diseases (≤5 involvements) (hazard ratio 0.28; 95% confidence interval 0.16–0.52) and the presence of neurological symptoms (hazard ratio 2.99; 95% confidence interval 1.54–5.81). Patients with scores 0, 1, 2 and 3 had a median overall survival of 44.4 (95% confidence interval 9.6–not reached), 20.4 (95% confidence interval 15.6–40.8), 12.0 (95% confidence interval 7.2–22.8) and 2.4 (95% confidence interval 1.2–not reached) years, respectively. The optimism-corrected c-indices for our proposed model, SIR and BS-BM were 0.65, 0.58 and 0.54, respectively.ConclusionsBrain metastasis growth kinetics is a valuable metric for survival outcomes of SRT. Our model is useful in identifying patients with brain metastasis treated with SRT with different overall survival. |
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| Keywords: | Brain metastases local control prognostic factors stereotactic radiotherapy survival |
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