A statistical comparison of prognostic index systems for brain metastases after stereotactic radiosurgery or fractionated stereotactic radiation therapy. 2013

G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada. george.rodrigues@lhsc.on.ca

OBJECTIVE Prognostic indices are commonly used in the context of brain metastases radiotherapy to guide patient decision-making and clinical trial stratification. The purpose of this investigation was to compare nine published brain metastases prognostic indices using traditional and novel statistical comparison metrics. METHODS A retrospective review was carried out on two institutional databases of 501 patients diagnosed with brain metastatic disease, who received either stereotactic radiosurgery (n = 381) or fractionated stereotactic radiation therapy (n = 120) between 2002 and 2011. Descriptive statistics were generated for patient, tumour and treatment factors, as well as prognostic indices distribution. To identify predictors of overall survival, Kaplan-Meier estimates and multivariable Cox proportional hazard analyses were carried out. Prognostic indices were compared with each other using novel metrics, including: net reclassification improvement (NRI) index, integrated discrimination improvement (IDI) index and decision curve analysis (DCA). RESULTS Multivariable Cox modelling confirmed the importance of all individual prognostic indices component factors except for 'active primary cancer' tumour status. When traditional and novel comparative metrics were incorporated, the available published prognostic indices were found to have important general classification benefits as follows: Radiation Therapy Oncology Group recursive partitioning analysis (RTOG RPA; NRI and DCA), Rades et al. first index (RADES I; IDI and DCA), Golden grading system (GGS; IDI and DCA) and Rotterdam index (RDAM; major misclassification rate and NRI). The graded prognostic assessment system had the smallest misclassification rate (5%) in terms of high-risk (i.e. poor prognosis) classification. CONCLUSIONS Summarising the various comparative approaches used in this report, we found that the RTOG RPA, GGS, RADES I and RDAM systems were superior in more than one metric studied. Of these, only the RTOG RPA has been extensively validated using large datasets and clinically utilised both at the patient level and in clinical trials.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D001932 Brain Neoplasms Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. Brain Cancer,Brain Metastases,Brain Tumors,Cancer of Brain,Malignant Primary Brain Tumors,Neoplasms, Intracranial,Benign Neoplasms, Brain,Brain Neoplasm, Primary,Brain Neoplasms, Benign,Brain Neoplasms, Malignant,Brain Neoplasms, Malignant, Primary,Brain Neoplasms, Primary Malignant,Brain Tumor, Primary,Brain Tumor, Recurrent,Cancer of the Brain,Intracranial Neoplasms,Malignant Neoplasms, Brain,Malignant Primary Brain Neoplasms,Neoplasms, Brain,Neoplasms, Brain, Benign,Neoplasms, Brain, Malignant,Neoplasms, Brain, Primary,Primary Brain Neoplasms,Primary Malignant Brain Neoplasms,Primary Malignant Brain Tumors,Benign Brain Neoplasm,Benign Brain Neoplasms,Benign Neoplasm, Brain,Brain Benign Neoplasm,Brain Benign Neoplasms,Brain Cancers,Brain Malignant Neoplasm,Brain Malignant Neoplasms,Brain Metastase,Brain Neoplasm,Brain Neoplasm, Benign,Brain Neoplasm, Malignant,Brain Neoplasms, Primary,Brain Tumor,Brain Tumors, Recurrent,Cancer, Brain,Intracranial Neoplasm,Malignant Brain Neoplasm,Malignant Brain Neoplasms,Malignant Neoplasm, Brain,Neoplasm, Brain,Neoplasm, Intracranial,Primary Brain Neoplasm,Primary Brain Tumor,Primary Brain Tumors,Recurrent Brain Tumor,Recurrent Brain Tumors,Tumor, Brain
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D015996 Survival Rate The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. Cumulative Survival Rate,Mean Survival Time,Cumulative Survival Rates,Mean Survival Times,Rate, Cumulative Survival,Rate, Survival,Rates, Cumulative Survival,Rates, Survival,Survival Rate, Cumulative,Survival Rates,Survival Rates, Cumulative,Survival Time, Mean,Survival Times, Mean,Time, Mean Survival,Times, Mean Survival
D016016 Proportional Hazards Models Statistical models used in survival analysis that assert that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time. Cox Model,Cox Proportional Hazards Model,Hazard Model,Hazards Model,Hazards Models,Models, Proportional Hazards,Proportional Hazard Model,Proportional Hazards Model,Cox Models,Cox Proportional Hazards Models,Hazard Models,Proportional Hazard Models,Hazard Model, Proportional,Hazard Models, Proportional,Hazards Model, Proportional,Hazards Models, Proportional,Model, Cox,Model, Hazard,Model, Hazards,Model, Proportional Hazard,Model, Proportional Hazards,Models, Cox,Models, Hazard,Models, Hazards,Models, Proportional Hazard
D016634 Radiosurgery A radiological stereotactic technique developed for cutting or destroying tissue by high doses of radiation in place of surgical incisions. It was originally developed for neurosurgery on structures in the brain and its use gradually spread to radiation surgery on extracranial structures as well. The usual rigid needles or probes of stereotactic surgery are replaced with beams of ionizing radiation directed toward a target so as to achieve local tissue destruction. Gamma Knife Radiosurgery,Linear Accelerator Radiosurgery,Stereotactic Body Radiotherapy,Stereotactic Radiosurgery,CyberKnife Radiosurgery,LINAC Radiosurgery,Radiosurgery, Gamma Knife,Radiosurgery, Linear Accelerator,Radiosurgery, Stereotactic,Stereotactic Radiation,Stereotactic Radiation Therapy,CyberKnife Radiosurgeries,Gamma Knife Radiosurgeries,LINAC Radiosurgeries,Linear Accelerator Radiosurgeries,Radiation Therapy, Stereotactic,Radiation, Stereotactic,Radiosurgery, CyberKnife,Radiosurgery, LINAC,Radiotherapy, Stereotactic Body,Stereotactic Body Radiotherapies,Stereotactic Radiation Therapies,Stereotactic Radiations,Stereotactic Radiosurgeries,Therapy, Stereotactic Radiation

Related Publications

G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
January 2019, Indian journal of cancer,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
January 1993, Acta neurochirurgica. Supplementum,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
November 2014, Journal of neuro-oncology,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
April 2015, American journal of clinical oncology,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
January 2017, Advances in radiation oncology,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
April 2014, Journal of neuro-oncology,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
May 2021, International journal of radiation oncology, biology, physics,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
October 2020, Neurosurgery clinics of North America,
G Rodrigues, and S Gonzalez-Maldonado, and G Bauman, and S Senan, and F Lagerwaard
September 2015, Journal of neuro-oncology,
Copied contents to your clipboard!