Applicability and limitations of a recently-proposed prognostic grading metric, initial brain metastasis velocity, for brain metastasis patients undergoing stereotactic radiosurgery

Masaaki Yamamoto, Hitoshi Aiyama, Takao Koiso, Shinya Watanabe, Takuya Kawabe, Yasunori Sato, Yoshinori Higuchi, Hidetoshi Kasuya, Bierta E. Barfod

Research output: Contribution to journalArticle

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Abstract

Purpose: This study, based on our brain metastasis (BM) patients undergoing stereotactic radiosurgery (SRS) procedures, aimed to validate whether the recently-proposed prognostic grading system, initial brain metastasis velocity (iBMV, scoring the cumulative number of BMs at the time of SRS divided by time [years] since the initial primary cancer diagnosis), is generally applicable. Methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3498 patients who underwent SRS for BMs during the 19.5-year-period between July, 1998 and December, 2017. We excluded four lost to follow-up, 24 for whom the day of primary cancer diagnosis was not available, 665 with synchronous presentation and 651 with pre-SRS radiotherapy and/or surgery, ultimately studying 2150 patients. Patients were categorized into two classes by iBMV scores, i.e., < 2.00 and ≥ 2.00. Results: In a multivariable model, iBMV was directly associated with a higher risk of death (p < 0.0001). The median survival time of patients with iBMV scores < 2.00, 10.0 (95% CI; 9.2–10.9) months, was longer than that of patients with iBMV scores ≥ 2.00, 6.3 (5.6–6.7) months, showing a significant difference between the two groups (HR 1.599, 95% CI 1.458–1.753, p < 0.0001). The same results were obtained in patients with non-small cell lung, breast, kidney or other cancers. Among 608 patients who underwent repeat SRS for newly-developed BMs, iBMV score categories correlated well with brain metastasis velocity risk groups (p < 0.0001). Conclusions: Our present results support the validity of iBMV for predicting survival after SRS.

Original languageEnglish
JournalJournal of Neuro-Oncology
DOIs
Publication statusPublished - 2019 Jan 1

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Radiosurgery
Neoplasm Metastasis
Brain
Neoplasms
Survival
Research Ethics Committees
Lost to Follow-Up
Reproducibility of Results
Breast
Cohort Studies
Radiotherapy
Retrospective Studies
Databases
Kidney
Lung

Keywords

  • Brain metastases
  • Gamma knife
  • Initial brain metastasis velocity
  • Prognosis
  • Radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Applicability and limitations of a recently-proposed prognostic grading metric, initial brain metastasis velocity, for brain metastasis patients undergoing stereotactic radiosurgery. / Yamamoto, Masaaki; Aiyama, Hitoshi; Koiso, Takao; Watanabe, Shinya; Kawabe, Takuya; Sato, Yasunori; Higuchi, Yoshinori; Kasuya, Hidetoshi; Barfod, Bierta E.

In: Journal of Neuro-Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Yamamoto, Masaaki ; Aiyama, Hitoshi ; Koiso, Takao ; Watanabe, Shinya ; Kawabe, Takuya ; Sato, Yasunori ; Higuchi, Yoshinori ; Kasuya, Hidetoshi ; Barfod, Bierta E. / Applicability and limitations of a recently-proposed prognostic grading metric, initial brain metastasis velocity, for brain metastasis patients undergoing stereotactic radiosurgery. In: Journal of Neuro-Oncology. 2019.
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T1 - Applicability and limitations of a recently-proposed prognostic grading metric, initial brain metastasis velocity, for brain metastasis patients undergoing stereotactic radiosurgery

AU - Yamamoto, Masaaki

AU - Aiyama, Hitoshi

AU - Koiso, Takao

AU - Watanabe, Shinya

AU - Kawabe, Takuya

AU - Sato, Yasunori

AU - Higuchi, Yoshinori

AU - Kasuya, Hidetoshi

AU - Barfod, Bierta E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: This study, based on our brain metastasis (BM) patients undergoing stereotactic radiosurgery (SRS) procedures, aimed to validate whether the recently-proposed prognostic grading system, initial brain metastasis velocity (iBMV, scoring the cumulative number of BMs at the time of SRS divided by time [years] since the initial primary cancer diagnosis), is generally applicable. Methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3498 patients who underwent SRS for BMs during the 19.5-year-period between July, 1998 and December, 2017. We excluded four lost to follow-up, 24 for whom the day of primary cancer diagnosis was not available, 665 with synchronous presentation and 651 with pre-SRS radiotherapy and/or surgery, ultimately studying 2150 patients. Patients were categorized into two classes by iBMV scores, i.e., < 2.00 and ≥ 2.00. Results: In a multivariable model, iBMV was directly associated with a higher risk of death (p < 0.0001). The median survival time of patients with iBMV scores < 2.00, 10.0 (95% CI; 9.2–10.9) months, was longer than that of patients with iBMV scores ≥ 2.00, 6.3 (5.6–6.7) months, showing a significant difference between the two groups (HR 1.599, 95% CI 1.458–1.753, p < 0.0001). The same results were obtained in patients with non-small cell lung, breast, kidney or other cancers. Among 608 patients who underwent repeat SRS for newly-developed BMs, iBMV score categories correlated well with brain metastasis velocity risk groups (p < 0.0001). Conclusions: Our present results support the validity of iBMV for predicting survival after SRS.

AB - Purpose: This study, based on our brain metastasis (BM) patients undergoing stereotactic radiosurgery (SRS) procedures, aimed to validate whether the recently-proposed prognostic grading system, initial brain metastasis velocity (iBMV, scoring the cumulative number of BMs at the time of SRS divided by time [years] since the initial primary cancer diagnosis), is generally applicable. Methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3498 patients who underwent SRS for BMs during the 19.5-year-period between July, 1998 and December, 2017. We excluded four lost to follow-up, 24 for whom the day of primary cancer diagnosis was not available, 665 with synchronous presentation and 651 with pre-SRS radiotherapy and/or surgery, ultimately studying 2150 patients. Patients were categorized into two classes by iBMV scores, i.e., < 2.00 and ≥ 2.00. Results: In a multivariable model, iBMV was directly associated with a higher risk of death (p < 0.0001). The median survival time of patients with iBMV scores < 2.00, 10.0 (95% CI; 9.2–10.9) months, was longer than that of patients with iBMV scores ≥ 2.00, 6.3 (5.6–6.7) months, showing a significant difference between the two groups (HR 1.599, 95% CI 1.458–1.753, p < 0.0001). The same results were obtained in patients with non-small cell lung, breast, kidney or other cancers. Among 608 patients who underwent repeat SRS for newly-developed BMs, iBMV score categories correlated well with brain metastasis velocity risk groups (p < 0.0001). Conclusions: Our present results support the validity of iBMV for predicting survival after SRS.

KW - Brain metastases

KW - Gamma knife

KW - Initial brain metastasis velocity

KW - Prognosis

KW - Radiosurgery

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