Predictors of individual tumor local control after stereotactic radiosurgery for non-small cell lung cancer brain metastases

Adam A. Garsa, Shahed N. Badiyan, Todd DeWees, Joseph R. Simpson, Jiayi Huang, Robert E. Drzymala, Igor J. Barani, Joshua L. Dowling, Keith M. Rich, Michael R. Chicoine, Albert H. Kim, Eric C. Leuthardt, Clifford G. Robinson

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate local control rates and predictors of individual tumor local control for brain metastases from non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS).

Methods and Materials: Between June 1998 and May 2011, 401 brain metastases in 228 patients were treated with Gamma Knife single-fraction SRS. Local failure was defined as an increase in lesion size after SRS. Local control was estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Receiver operating characteristic analysis was used to identify an optimal cutpoint for conformality index relative to local control. A P value <.05 was considered statistically significant.

Results: Median age was 60 years (range, 27-84 years). There were 66 cerebellar metastases (16%) and 335 supratentorial metastases (84%). The median prescription dose was 20 Gy (range, 14-24 Gy). Median overall survival from time of SRS was 12.1 months. The estimated local control at 12 months was 74%. On multivariate analysis, cerebellar location (hazard ratio [HR] 1.94, P=.009), larger tumor volume (HR 1.09, P<.001), and lower conformality (HR 0.700, P=.044) were significant independent predictors of local failure. Conformality index cutpoints of 1.4-1.9 were predictive of local control, whereas a cutpoint of 1.75 was the most predictive (P=.001). The adjusted Kaplan-Meier 1-year local control for conformality index ≥1.75 was 84% versus 69% for conformality index <1.75, controlling for tumor volume and location. The 1-year adjusted local control for cerebellar lesions was 60%, compared with 77% for supratentorial lesions, controlling for tumor volume and conformality index.

Conclusions: Cerebellar tumor location, lower conformality index, and larger tumor volume were significant independent predictors of local failure after SRS for brain metastases from NSCLC. These results warrant further investigation in a prospective setting.

Original languageEnglish (US)
Pages (from-to)407-413
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume90
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Radiosurgery
metastasis
Non-Small Cell Lung Carcinoma
Brain Neoplasms
lungs
brain
Tumor Burden
tumors
cancer
Neoplasm Metastasis
predictions
hazards
Neoplasms
lesions
Brain
Multivariate Analysis
Cerebellar Neoplasms
Proportional Hazards Models
ROC Curve
Prescriptions

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Predictors of individual tumor local control after stereotactic radiosurgery for non-small cell lung cancer brain metastases. / Garsa, Adam A.; Badiyan, Shahed N.; DeWees, Todd; Simpson, Joseph R.; Huang, Jiayi; Drzymala, Robert E.; Barani, Igor J.; Dowling, Joshua L.; Rich, Keith M.; Chicoine, Michael R.; Kim, Albert H.; Leuthardt, Eric C.; Robinson, Clifford G.

In: International Journal of Radiation Oncology Biology Physics, Vol. 90, No. 2, 01.01.2014, p. 407-413.

Research output: Contribution to journalArticle

Garsa, AA, Badiyan, SN, DeWees, T, Simpson, JR, Huang, J, Drzymala, RE, Barani, IJ, Dowling, JL, Rich, KM, Chicoine, MR, Kim, AH, Leuthardt, EC & Robinson, CG 2014, 'Predictors of individual tumor local control after stereotactic radiosurgery for non-small cell lung cancer brain metastases', International Journal of Radiation Oncology Biology Physics, vol. 90, no. 2, pp. 407-413. https://doi.org/10.1016/j.ijrobp.2014.05.047
Garsa, Adam A. ; Badiyan, Shahed N. ; DeWees, Todd ; Simpson, Joseph R. ; Huang, Jiayi ; Drzymala, Robert E. ; Barani, Igor J. ; Dowling, Joshua L. ; Rich, Keith M. ; Chicoine, Michael R. ; Kim, Albert H. ; Leuthardt, Eric C. ; Robinson, Clifford G. / Predictors of individual tumor local control after stereotactic radiosurgery for non-small cell lung cancer brain metastases. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 90, No. 2. pp. 407-413.
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abstract = "Purpose: To evaluate local control rates and predictors of individual tumor local control for brain metastases from non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS).Methods and Materials: Between June 1998 and May 2011, 401 brain metastases in 228 patients were treated with Gamma Knife single-fraction SRS. Local failure was defined as an increase in lesion size after SRS. Local control was estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Receiver operating characteristic analysis was used to identify an optimal cutpoint for conformality index relative to local control. A P value <.05 was considered statistically significant.Results: Median age was 60 years (range, 27-84 years). There were 66 cerebellar metastases (16{\%}) and 335 supratentorial metastases (84{\%}). The median prescription dose was 20 Gy (range, 14-24 Gy). Median overall survival from time of SRS was 12.1 months. The estimated local control at 12 months was 74{\%}. On multivariate analysis, cerebellar location (hazard ratio [HR] 1.94, P=.009), larger tumor volume (HR 1.09, P<.001), and lower conformality (HR 0.700, P=.044) were significant independent predictors of local failure. Conformality index cutpoints of 1.4-1.9 were predictive of local control, whereas a cutpoint of 1.75 was the most predictive (P=.001). The adjusted Kaplan-Meier 1-year local control for conformality index ≥1.75 was 84{\%} versus 69{\%} for conformality index <1.75, controlling for tumor volume and location. The 1-year adjusted local control for cerebellar lesions was 60{\%}, compared with 77{\%} for supratentorial lesions, controlling for tumor volume and conformality index.Conclusions: Cerebellar tumor location, lower conformality index, and larger tumor volume were significant independent predictors of local failure after SRS for brain metastases from NSCLC. These results warrant further investigation in a prospective setting.",
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AU - Garsa, Adam A.

AU - Badiyan, Shahed N.

AU - DeWees, Todd

AU - Simpson, Joseph R.

AU - Huang, Jiayi

AU - Drzymala, Robert E.

AU - Barani, Igor J.

AU - Dowling, Joshua L.

AU - Rich, Keith M.

AU - Chicoine, Michael R.

AU - Kim, Albert H.

AU - Leuthardt, Eric C.

AU - Robinson, Clifford G.

PY - 2014/1/1

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N2 - Purpose: To evaluate local control rates and predictors of individual tumor local control for brain metastases from non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS).Methods and Materials: Between June 1998 and May 2011, 401 brain metastases in 228 patients were treated with Gamma Knife single-fraction SRS. Local failure was defined as an increase in lesion size after SRS. Local control was estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Receiver operating characteristic analysis was used to identify an optimal cutpoint for conformality index relative to local control. A P value <.05 was considered statistically significant.Results: Median age was 60 years (range, 27-84 years). There were 66 cerebellar metastases (16%) and 335 supratentorial metastases (84%). The median prescription dose was 20 Gy (range, 14-24 Gy). Median overall survival from time of SRS was 12.1 months. The estimated local control at 12 months was 74%. On multivariate analysis, cerebellar location (hazard ratio [HR] 1.94, P=.009), larger tumor volume (HR 1.09, P<.001), and lower conformality (HR 0.700, P=.044) were significant independent predictors of local failure. Conformality index cutpoints of 1.4-1.9 were predictive of local control, whereas a cutpoint of 1.75 was the most predictive (P=.001). The adjusted Kaplan-Meier 1-year local control for conformality index ≥1.75 was 84% versus 69% for conformality index <1.75, controlling for tumor volume and location. The 1-year adjusted local control for cerebellar lesions was 60%, compared with 77% for supratentorial lesions, controlling for tumor volume and conformality index.Conclusions: Cerebellar tumor location, lower conformality index, and larger tumor volume were significant independent predictors of local failure after SRS for brain metastases from NSCLC. These results warrant further investigation in a prospective setting.

AB - Purpose: To evaluate local control rates and predictors of individual tumor local control for brain metastases from non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS).Methods and Materials: Between June 1998 and May 2011, 401 brain metastases in 228 patients were treated with Gamma Knife single-fraction SRS. Local failure was defined as an increase in lesion size after SRS. Local control was estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Receiver operating characteristic analysis was used to identify an optimal cutpoint for conformality index relative to local control. A P value <.05 was considered statistically significant.Results: Median age was 60 years (range, 27-84 years). There were 66 cerebellar metastases (16%) and 335 supratentorial metastases (84%). The median prescription dose was 20 Gy (range, 14-24 Gy). Median overall survival from time of SRS was 12.1 months. The estimated local control at 12 months was 74%. On multivariate analysis, cerebellar location (hazard ratio [HR] 1.94, P=.009), larger tumor volume (HR 1.09, P<.001), and lower conformality (HR 0.700, P=.044) were significant independent predictors of local failure. Conformality index cutpoints of 1.4-1.9 were predictive of local control, whereas a cutpoint of 1.75 was the most predictive (P=.001). The adjusted Kaplan-Meier 1-year local control for conformality index ≥1.75 was 84% versus 69% for conformality index <1.75, controlling for tumor volume and location. The 1-year adjusted local control for cerebellar lesions was 60%, compared with 77% for supratentorial lesions, controlling for tumor volume and conformality index.Conclusions: Cerebellar tumor location, lower conformality index, and larger tumor volume were significant independent predictors of local failure after SRS for brain metastases from NSCLC. These results warrant further investigation in a prospective setting.

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