Cumulative intracranial tumor volume prognostic assessment (CITVPA): a new predicting score index for patients affected by brain metastases treated with gamma knife stereotactic radiosurgery
EANS Academy. Donofrio C. Sep 26, 2019; 276080; EP07007
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Purpose: To identify a new prognostic model for patients affected by brain metastases (BM) who underwent Gamma Knife Radiosurgery (GKRS).
Methods: Between January 2001 and December 2015, 1894 consecutive patients underwent GKRS at San Raffaele Hospital for BM.The main patient, tumor and treatment characteristics were prospectively collected and retrospectively analyzed.The ROC curve was computed for CITV and used to define the cut-off values according to the Youden's index (YI).The multivariate analysis was performed using a Cox proportional hazard model.The predictive discrimination powers of each prognostic model were compared through the Harrel c-index (HCI) computation.
Results: The median marginal prescription dose was 25.0 Gy and the isodose ranged between 40% and 60%.The mean CITV was 4.7 cc (median:2.5 cc), and, according to the ROC curve, the CITV cut-off points were set at 1.5 (sens:0.72;spec:0.42;YI:0.14) and 4.0 cc (sens:0.46;spec:0.71;YI:0.17).Thereafter, based on the multivariate analysis, we build the CITVPA model, including: age (O.R.:1.010,95%C.I.:1.005-1.015,p< 0.001), KPS (O.R.:0.960,95%C.I.:0.956-0.965,p< 0.001), presence of extracranial metastases (O.R.:1.287,95%C.I.:1.154-1.437,p< 0.001), BM number (O.R.:1.193,95%C.I.:1.047-1.360,p= 0.008), and CITV (O.R.:1.028,95%C.I.:1.020-1.036,p< 0.001).A score of 0, 0.5 or 1 was attributed to each prognostic factor: age (< 50,50-59,≥ 60 years), KPS (≥ 90,70-80,≤ 60), presence of extracranial metastases (absent,present), BM number (single,multiple) and CITV (≤ 1.5,1.51-3.99,≥ 4.0cc).Subsequently, a global CITVPA score ranging from 0 to 5 was assigned to each patient, with higher results corresponding to the worst outcomes.Then, we evaluated the predictivity of each CITVPA class inside its model with a Cox analysis, and we found relevant differences between each prognostic group (p< 0.001).Finally, we compared the CITVPA to other models and we obtained that the CITVPA (HCI=0.64) exhibited the highest discriminative power (p< 0.001) compared to RPA (HCI=0.55), SIR (HCI=0.55) and GPA (HCI=0.61).
Conclusions: The CITVPA displays the highest predictive worth for patients affected by BM and guarantees simple applicability in clinical practice.
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