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A survival score for patients with brain metastases from less radiosensitive tumors treated with whole-brain radiotherapy alone

Ein Überlebensscore für Patienten mit Hirnmetastasen von gering strahlensensiblen Tumoren nach alleiniger Ganzhirnbestrahlung

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Abstract

Background and purpose

This study aimed to develop and validate a scoring system to predict the survival of patients receiving whole-brain radiotherapy (WBRT) alone for brain metastases from less radiosensitive tumors.

Patients and methods

The study included data from 176 patients with brain metastasis from renal cell carcinoma, malignant melanoma or colorectal cancer. Patients were divided into a test group (N = 88) and a validation group (N = 88). In the multivariate analysis of the test group, age, Karnofsky Performance Status and extracranial metastasis were significantly associated with survival. These three factors were included in the scoring system. The score for each factor was determined by dividing the 6-month survival rate (in %) by 10. The total score represented the sum of the three scores. According to the total scores—which ranged from 5 to14 points—three prognostic groups were created.

Results

The 6-month survival rates in the test group were 11 % for 5–8 points (N = 47, group A), 38 % for 9–11 points (N = 29, group B) and 83 % for 12–14 points (N = 12, group C). In the validation group the 6-month survival rates were 12, 31  and 75 %, respectively. Comparisons between the prognostic groups A, B and C of the test group with those of the validation group did not reveal any significant differences.

Conclusion

The new scoring system based on three independent prognostic factors can help to estimate the survival of patients with brain metastases from a less radiosensitive tumor. The score appears to be valid and reproducible.

Zusammenfassung

Hintergrund und Ziel

Ziel dieser Studie war es, einen Score zu entwickeln und zu validieren, mit dem die Überlebensprognose von Patienten mit Hirnmetastasen von gering strahlensensiblen Tumoren nach alleiniger Ganzhirnbestrahlung (WBRT) abgeschätzt werden kann.

Patienten und Methoden

Die Studie enthielt Daten von 176 Patienten mit Hirnmetastasen eines Nierenzellkarzinoms, eines malignen Melanoms oder eines kolorektalen Karzinoms, die in eine Testgruppe (n = 88) und eine Validierungsgruppe (n = 88) aufgeteilt wurden. In der Multivarianzanalyse der Testgruppe waren Alter, Karnofsky-Index und extrakranielle Metastasierung signifikant mit dem Überleben assoziiert. Diese 3 Faktoren wurden in dem Scoringsystem berücksichtigt. Der Score wurde für jeden Faktor ermittelt, indem die Überlebensrate nach 6 Monaten (in %) durch 10 dividiert wurde. Der jeweilige Gesamtscore entsprach der Summe der 3 Einzelscores. Unter Berücksichtigung der Gesamtscores, die zwischen 5 und 14 Punkten betrugen, wurden 3 Prognosegruppen gebildet.

Ergebnisse

Die Überlebensraten nach 6 Monaten in der Testgruppe betrugen 11 % bei 5–8 Punkten (n = 47, Gruppe A), 38 % bei 9–11 Punkten (n = 29, Gruppe B) und 83 % bei 12–14 Punkten (n = 12, Gruppe C). In der Validierungsgruppe lagen die Überlebensraten bei 12, 31 und 75 %. Die Vergleiche zwischen der Test- und der Validierungsgruppe für die 3 Prognosegruppen A, B und C ergaben keine signifikanten Unterschiede.

Schlussfolgerungen

Dieses neue Scoringsystem, das auf 3 unabhängigen Prognosefaktoren beruht, kann dazu beitragen, die Überlebensprognose von Patienten mit Hirnmetastasen von gering strahlensensiblen Tumoren abzuschätzen. Der Score erscheint valide und reproduzierbar.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Correspondence to D. Rades M.D..

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Dziggel, L., Segedin, B., Podvrsnik, N. et al. A survival score for patients with brain metastases from less radiosensitive tumors treated with whole-brain radiotherapy alone. Strahlenther Onkol 190, 54–58 (2014). https://doi.org/10.1007/s00066-013-0394-2

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