Predicting intracranial progression following stereotactic radiosurgery for brain metastases: Implications for post SRS imaging

Brahma D. Natarajan, Christel N. Rushing, Michael A. Cummings, Jessica M.S. Jutzy, Kingshuk R. Choudhury, Michael J. Moravan, Peter E. Fecci, Justus Adamson, Steven J. Chmura, Michael T. Milano, John P. Kirkpatrick, Joseph K. Salama

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Purpose: Follow-up imaging after stereotactic radiosurgery (SRS) is crucial to identify salvageable brain metastases (BM) recurrence. As optimal imaging intervals are poorly understood, we sought to build a predictive model for time to intracranial progression. Methods: Consecutive patients treated with SRS for BM at three institutions from January 1, 2002 to June 30, 2017 were retrospectively reviewed. We developed a model using stepwise regression that identified four prognostic factors and built a predictive nomogram. Results: We identified 755 patients with primarily non-small cell lung, breast, and melanoma BMs. Factors such as number of BMs, histology, history of prior whole-brain radiation, and time interval from initial cancer diagnosis to metastases were prognostic for intracranial progression. Per our nomogram, risk of intracranial progression by 3 months post-SRS in the high-risk group was 21% compared to 11% in the low-risk group; at 6 months, it was 43% versus 27%. Conclusion: We present a nomogram estimating time to BM progression following SRS to potentially personalize surveillance imaging.

Original languageEnglish
Pages (from-to)179-187
Number of pages9
JournalJournal of Radiosurgery and SBRT
Volume6
Issue number3
StatePublished - 2019

Keywords

  • Brain metastases
  • Nomogram
  • Salvage therapy
  • Surveillance imaging

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