Prognostic indices in stereotactic radiotherapy of brain metastases of non-small cell lung cancerReport as inadecuate

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Radiation Oncology

, 10:244

Clinical Radiation Oncology


BackgroundOur purpose was to analyze the long-term clinical outcome and to identify prognostic factors after Linac-based stereotactic radiosurgery SRS or fractionated stereotactic radiotherapy FSRT on patients with brain metastases BM from non-small cell lung cancer NSCLC.

Materials and MethodsWe performed a retrospective analysis of survival on 90 patients who underwent SRS or FSRT of intracranial NSCLC metastases between 04-2004 and 05-2014 that had not undergone prior surgery or whole brain radiotherapy WBRT for BM. Follow-up data was analyzed until May 2015. Potential prognostic factors were examined in univariable and multivariable analyses. The Golden Grading System GGS, the disease-specific graded prognostic assessment DS-GPA, the RADES II prognostic index as well as the NSCLC-specific index proposed by Rades et al. in 2013 NSCLC-RADES were calculated and their predictive values were tested in univariable analysis.

ResultsThe median follow-up time of the surviving patients was 14 months.

The overall survival OS rate was 51 % after 6 months and 29.9 % after 12 months.

Statistically significant factors of better OS after univariable analysis were lower International Union Against Cancer UICC stage at first diagnosis, histology of adenocarcinoma, prior surgery of the primary tumor and lower total BM volume. After multivariable analysis adenocarcinoma histology remained a significant factor; higher Karnofsky Performance Score KPS and the presence of extracranial metastases ECM were also significant.

The RADES II and the NSCLC-RADES indices were significant predictors of OS. However, the NSCLC-RADES failed to differentiate between intermediate- and low-risk patients. The DS-GPA and GGS were not statistically significant predictors of survival in univariable analysis.

ConclusionThe ideal prognostic index has not been defined yet. We believe that more specific indices will be developed in the future. Our results indicate that the histologic subtype of NSCLC could add to the prognostic value of specialized future indices. The RADES II index had the highest predictive value in the examined patient cohort.

KeywordsBrain metastases Radiation therapy Survival Prognostic scores David Kaul and Alexander Angelidis contributed equally to this work.

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Author: David Kaul - Alexander Angelidis - Volker Budach - Pirus Ghadjar - Markus Kufeld - Harun Badakhshi


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