TY - JOUR
T1 - Development and validation of a unifying pre-treatment decision tool for intracranial and extracranial metastasis-directed radiotherapy
AU - Kowalchuk, Roman
AU - Mullikin, Trey C.
AU - Breen, William
AU - Gits, Hunter C.
AU - Florez, Marcus
AU - De, Brian
AU - Harmsen, William S.
AU - Rose, Peter Sean
AU - Siontis, Brittany L.
AU - Costello, Brian A.
AU - Morris, Jonathan M.
AU - Lucido, John J.
AU - Olivier, Kenneth R.
AU - Stish, Brad
AU - Laack, Nadia N.
AU - Park, Sean
AU - Owen, Dawn
AU - Ghia, Amol J.
AU - Brown, Paul D.
AU - Merrell, Kenneth Wing
N1 - Publisher Copyright:
Copyright © 2023 Kowalchuk, Mullikin, Breen, Gits, Florez, De, Harmsen, Rose, Siontis, Costello, Morris, Lucido, Olivier, Stish, Laack, Park, Owen, Ghia, Brown and Merrell.
PY - 2023
Y1 - 2023
N2 - Background: Though metastasis-directed therapy (MDT) has the potential to improve overall survival (OS), appropriate patient selection remains challenging. We aimed to develop a model predictive of OS to refine patient selection for clinical trials and MDT. Patients and methods: We assembled a multi-institutional cohort of patients treated with MDT (stereotactic body radiation therapy, radiosurgery, and whole brain radiation therapy). Candidate variables for recursive partitioning analysis were selected per prior studies: ECOG performance status, time from primary diagnosis, number of additional non-target organ systems involved (NOS), and intracranial metastases. Results: A database of 1,362 patients was assembled with 424 intracranial, 352 lung, and 607 spinal treatments (n=1,383). Treatments were split into training (TC) (70%, n=968) and internal validation (IVC) (30%, n=415) cohorts. The TC had median ECOG of 0 (interquartile range [IQR]: 0-1), NOS of 1 (IQR: 0-1), and OS of 18 months (IQR: 7-35). The resulting model components and weights were: ECOG = 0, 1, and > 1 (0, 1, and 2); 0, 1, and > 1 NOS (0, 1, and 2); and intracranial target (2), with lower scores indicating more favorable OS. The model demonstrated high concordance in the TC (0.72) and IVC (0.72). The score also demonstrated high concordance for each target site (spine, brain, and lung). Conclusion: This pre-treatment decision tool represents a unifying model for both intracranial and extracranial disease and identifies patients with the longest survival after MDT who may benefit most from aggressive local therapy. Carefully selected patients may benefit from MDT even in the presence of intracranial disease, and this model may help guide patient selection for MDT.
AB - Background: Though metastasis-directed therapy (MDT) has the potential to improve overall survival (OS), appropriate patient selection remains challenging. We aimed to develop a model predictive of OS to refine patient selection for clinical trials and MDT. Patients and methods: We assembled a multi-institutional cohort of patients treated with MDT (stereotactic body radiation therapy, radiosurgery, and whole brain radiation therapy). Candidate variables for recursive partitioning analysis were selected per prior studies: ECOG performance status, time from primary diagnosis, number of additional non-target organ systems involved (NOS), and intracranial metastases. Results: A database of 1,362 patients was assembled with 424 intracranial, 352 lung, and 607 spinal treatments (n=1,383). Treatments were split into training (TC) (70%, n=968) and internal validation (IVC) (30%, n=415) cohorts. The TC had median ECOG of 0 (interquartile range [IQR]: 0-1), NOS of 1 (IQR: 0-1), and OS of 18 months (IQR: 7-35). The resulting model components and weights were: ECOG = 0, 1, and > 1 (0, 1, and 2); 0, 1, and > 1 NOS (0, 1, and 2); and intracranial target (2), with lower scores indicating more favorable OS. The model demonstrated high concordance in the TC (0.72) and IVC (0.72). The score also demonstrated high concordance for each target site (spine, brain, and lung). Conclusion: This pre-treatment decision tool represents a unifying model for both intracranial and extracranial disease and identifies patients with the longest survival after MDT who may benefit most from aggressive local therapy. Carefully selected patients may benefit from MDT even in the presence of intracranial disease, and this model may help guide patient selection for MDT.
KW - metastasis-directed radiotherapy
KW - metastatic disease
KW - modeling
KW - oligometastasis
KW - outcomes
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U2 - 10.3389/fonc.2023.1095170
DO - 10.3389/fonc.2023.1095170
M3 - Article
AN - SCOPUS:85152555277
SN - 2234-943X
VL - 13
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 1095170
ER -