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Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Routine brain MRI surveillance frequently diagnoses small, asymptomatic brain metastases from non-small cell lung cancer (NSCLC) that are effectively treated with stereotactic radiosurgery (SRS). A subset of patients, however, may die prior to the onset of symptoms. This study identifies clinical features that distinguish neurologically-asymptomatic NSCLC brain metastases patients that die prior to routine 3 month follow-up after SRS.

Methods

Retrospective chart review from 2007 to 2017 identified 18 patients with neurologically-asymptomatic NSCLC brain metastases who died < 3 months after SRS. Twenty-eight additional patients meeting criteria and surviving > 6 months after SRS were identified. Clinical factors were examined to determine characteristics correlated with survival using cox proportional hazards and nominal logistic regression models. Logistic regression models using salient factors were trained with 10-fold cross-validation and compared to the graded prognostic assessment (GPA) and score index of radiosurgery (SIR) using the AUC from receiver operant characteristic curves.

Results

The median survival following SRS was 1.4 and 9.2 months for the < 3 months and > 6 months groups, respectively. Age, number of brain metastases, and Karnofsky performance status were associated with overall survival while gender and interval between primary cancer and first brain metastasis diagnoses were associated with < 3 months and > 6 months survival, respectively. Models using GPA and SIR performed poorly compared to preliminary metrics generated in this study for prognosis of both < 3 months and > 6 months survival.

Conclusion

Physicians require data to provide high-value, cost-conscious health care. Clinical metrics can screen patients with asymptomatic NSCLC brain metastases likely to die prior to the standard screening interval and observation could be considered.

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Authors and Affiliations

  1. Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA

    Bina Kakusa, Summer Han, Gordon Li & Melanie Hayden Gephart

  2. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA

    Sonya Aggarwal & Scott Soltys

  3. Department of Biology, Stanford University School of Medicine, Stanford, CA, USA

    Boxiang Liu

  4. Stanford University School of Medicine, 300 Pasteur Drive MC 5327, 94305, Stanford, CA, USA

    Bina Kakusa & Melanie Hayden Gephart

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  1. Bina Kakusa
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  2. Summer Han
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  3. Sonya Aggarwal
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  4. Boxiang Liu
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  5. Gordon Li
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Correspondence to Melanie Hayden Gephart.

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Kakusa, B., Han, S., Aggarwal, S. et al. Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer. J Neurooncol 140, 705–715 (2018). https://doi.org/10.1007/s11060-018-03002-0

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