Predictors for a further local in-brain progression after re-craniotomy of locally recurrent cerebral metastases

Kamp, Marcel A.; Fischer, Igor; Dibué-Adjei, Maxine; Munoz-Bendix, Christopher; Cornelius, J.F.; Steiger, Hans‐Jakob; Slotty, Philipp J.; Turowski, Bernd; Rapp, Marion; Sabel, Michael

doi:10.1007/s10143-017-0931-z

Cited by 13 publications

(14 citation statements)

References 43 publications

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“…Moreover, the study should provide a basis upon which other local salvage treatment concepts, such as OTR, could be compared to. In a mere comparison of survival data, PRS rates after OTR are comparable to our PRS rates after salvage CyberKnife: retrospective data on salvage OTR suggest a PRS range between 7.5 and 12.9 months [4-5]. These ranges are determined by disease- and patient-specific differences.…”

Section: Discussionsupporting

confidence: 72%

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CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Romagna¹,

Schwartz

Ladisich

et al. 2018

Cureus

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IntroductionLocal treatment concepts are in high demand in the salvage treatment of recurrent brain metastases. Still, their risks and benefits are scarcely characterized. In this study, we analyzed the outcome and risk-/benefit-ratio of salvage CyberKnife (Accuray Incorporated, Sunnyvale, California, US) radiosurgery in the treatment of recurrent brain metastases after whole brain radiotherapy (WBRT).Materials and methodsSeventy-six patients with 166 recurrent brain metastases and a multimodal pretreatment were retrospectively investigated. All patients underwent salvage CyberKnife radiosurgery (single fraction, reference dose: 17-22 Gy). Study endpoints were post-recurrence survival (PRS) after salvage treatment as well as local and distant tumor control rates. Central nervous system (CNS) toxicity was assessed according to the toxicity criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC)).ResultsThe population was homogenous regarding its demographic parameters. All patients had a history of WBRT prior to salvage CyberKnife radiosurgery. PRS was 13.3 months (10.4 - 16.2 months), one-year local and distant tumor control rates were 87% (95% CI: 75-99) and 38% (95% CI: 23-52), respectively. Eighteen patients suffered from RTOG/EORTC grade I/II toxicity. No toxicity-related risk factors were identified.DiscussionThis study found indicative survival and tumor control rates as well as a favorable risk/benefit ratio regarding radiotoxicity in salvage CyberKnife radiosurgery. These results point to a proactive therapeutic strategy based on appropriate patient selection instead of therapeutic nihilism.

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Section: Discussionsupporting

confidence: 72%

“…Aside from survival, the matter of safety remains a major concern in the salvage treatment of brain metastases. The oncological impact of salvage radiotherapy has to be balanced against the known risk of radionecrosis and morbidity [4].…”

Section: Introductionmentioning

confidence: 99%

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Romagna¹,

Schwartz

Ladisich

et al. 2018

Cureus

View full text Add to dashboard Cite

show abstract

“…Moreover, the study should provide a basis upon which other local salvage treatment concepts, such as OTR, could be compared to. In a mere comparison of survival data, PRS rates after OTR are comparable to our PRS rates after salvage CyberKnife: retrospective data on salvage OTR suggest a PRS range between 7.5 and 12.9 months [4][5]. These ranges are determined by disease-and patientspecific differences.…”

Section: Discussionsupporting

confidence: 74%

“…The lack of standardized treatment algorithms for these patients leads to a variety of individualized salvage treatment strategies [3]. Possible concepts consist of local treatment options (percutaneous radiotherapy/radiosurgery, open tumor resection (OTR), and lowactivity iodine-125 brachytherapy (SBT) or systemic chemotherapy and/or any combinations thereof [3][4][5][6]. For salvage radiosurgery, a post-recurrence survival (PRS) range between 4.5 and 22.4 months -depending on the tumor entity -has been reported [7][8].…”

Section: Introductionmentioning

confidence: 99%

Correction

Romagna

Schwartz

Ladisich

et al. 2019

Cureus

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“…6-9 In practice, this has allowed for good outcomes after BM resection beyond the inclusion criteria of the clinical trials, such as those with multiple BMs 10,11 or those with a locally recurrent BM. 12-14…”

mentioning

confidence: 99%

Survival Prediction After Neurosurgical Resection of Brain Metastases: A Machine Learning Approach

Hulsbergen

Awakimjan

et al. 2022

Neurosurgery

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BACKGROUND:Current prognostic models for brain metastases (BMs) have been constructed and validated almost entirely with data from patients receiving up-front radiotherapy, leaving uncertainty about surgical patients.OBJECTIVE:To build and validate a model predicting 6-month survival after BM resection using different machine learning algorithms.METHODS:An institutional database of 1062 patients who underwent resection for BM was split into an 80:20 training and testing set. Seven different machine learning algorithms were trained and assessed for performance; an established prognostic model for patients with BM undergoing radiotherapy, the diagnosis-specific graded prognostic assessment, was also evaluated. Model performance was assessed using area under the curve (AUC) and calibration.RESULTS:The logistic regression showed the best performance with an AUC of 0.71 in the hold-out test set, a calibration slope of 0.76, and a calibration intercept of 0.03. The diagnosis-specific graded prognostic assessment had an AUC of 0.66. Patients were stratified into regular-risk, high-risk and very high-risk groups for death at 6 months; these strata strongly predicted both 6-month and longitudinal overall survival (P < .0005). The model was implemented into a web application that can be accessed through http://brainmets.morethanml.com.CONCLUSION:We developed and internally validated a prediction model that accurately predicts 6-month survival after neurosurgical resection for BM and allows for meaningful risk stratification. Future efforts should focus on external validation of our model.

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Predictors for a further local in-brain progression after re-craniotomy of locally recurrent cerebral metastases

Cited by 13 publications

References 43 publications

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Correction

Survival Prediction After Neurosurgical Resection of Brain Metastases: A Machine Learning Approach

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