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Cumulative intracranial tumour volume prognostic assessment: a new predicting score index for patients with brain metastases treated by stereotactic radiosurgery

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Abstract

Brain metastases (BM) represent the most common intracranial malignancy in adults. Limitations of existing prognostic models reduce their predictivity and clinical applicability. The aim of this study is to validate the cumulative intracranial tumour volume prognostic assessment (CITVPA) as a new prognostic score system for patients with BM treated by Stereotactic Radiosurgery (SRS). Between January 2001 and December 2015, 1894 patients underwent Gamma Knife SRS treatment. The CITVPA model was implemented and validated as follows: the CITV cut-offs were identified thanks to a receiver-operating characteristic (ROC) curve analysis; the survival predictive factors were selected through a Cox proportional hazard model; its prognostic power was compared to RPA, SIR and GPA through the Harrel concordance index (HCI). According to the ROC curve analysis, the CITV cut-off values were set at 1.5 and 4.0 cc. Based on the multivariate analysis, the CITVPA model included: age (OR 1.010, 95% CI 1.005–1.015, p < 0.001), KPS (OR 0.960, 95% CI 0.956–0.965, p < 0.001), extracranial metastases (OR 1.287, 95% CI 1.154–1.437, p < 0.001), BM number (OR 1.193, 95% CI 1.047–1.360, p = 0.008), and CITV (OR 1.028, 95% CI 1.020–1.036, p < 0.001). A score between 0 and 1 was attributed to each prognosticator; a global CITVPA score ranging from 0 to 5 was assigned with higher results corresponding to worse outcomes. The CITVPA (HCI = 0.64) exhibited a significantly (p < 0.001) higher prognostic power compared to RPA (HCI = 0.55), SIR (HCI = 0.55) and GPA (HCI = 0.61). The CITVPA represents a reliable prognostic system for patients with BM treated by SRS. However, further prospective and multicentric studies are necessary before its applicability in clinical practice.

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Acknowledgements

The authors would thank Mr James Minshull for the English language revision.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Carmine Antonio Donofrio, Andrea Cavalli, Lucia Riccio, Pietro Panni, Camillo Ferrari da Passano & Pietro Mortini

  2. Service of Anaesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Italy

    Marco Gemma

  3. Department of Radiation Oncology, Brescia University, ASST Spedali Civili di Brescia, Brescia, Italy

    Alessandra Donofrio

  4. Service of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Antonella Del Vecchio

  5. Service of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Angelo Bolognesi

  6. Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy

    Riccardo Soffietti

Authors
  1. Carmine Antonio Donofrio
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  2. Andrea Cavalli
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Contributions

CAD: conceptualization, data curation, analysis and interpretation, investigation, methodology, validation, visualization, writing – original draft, and writing—review and editing. AC: conceptualization, data curation, investigation, methodology, validation, and writing—review and editing. MG: data analysis and interpretation analysis, methodology, validation, and writing—review and editing. LR: data curation, analysis and interpretation, validation, visualization, writing—original draft, and writing—review and editing. AD: data analysis and interpretation, validation, visualization, writing—original draft, and writing—review and editing. PP: data curation and analysis, validation, visualization, and writing—review and editing. CFdP: data curation and interpretation, validation, and writing—review and editing. AdV: data curation and interpretation, validation, and writing—review and editing. AB: data curation and interpretation, validation, and writing—review and editing. RS: data interpretation, supervision, validation, and writing—review and editing. PM: data interpretation, supervision, validation, and writing—review and editing.

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Correspondence to Carmine Antonio Donofrio.

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Donofrio, C.A., Cavalli, A., Gemma, M. et al. Cumulative intracranial tumour volume prognostic assessment: a new predicting score index for patients with brain metastases treated by stereotactic radiosurgery. Clin Exp Metastasis 37, 499–508 (2020). https://doi.org/10.1007/s10585-020-10037-z

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