scholarly journals Cumulative Intracranial Tumor Volume Augments the Prognostic Value of Diagnosis-Specific Graded Prognostic Assessment Model for Survival in Patients with Melanoma Cerebral Metastases

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 237-244 ◽  
Author(s):  
Brian R Hirshman ◽  
Bayard R Wilson ◽  
Mir Amaan Ali ◽  
Alexander J Schupper ◽  
James A Proudfoot ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Tumor Volume ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Intracranial Tumor ◽  
Assessment Model ◽  
Prognostic Assessment ◽  
Prognostic Accuracy ◽  
Graded Prognostic Assessment ◽  
Independent Cohort

Abstract BACKGROUND The diagnosis-specific graded prognostic assessment scale (ds-GPA) for patients with melanoma brain metastasis (BM) utilizes only 2 key prognostic variables: Karnofsky performance status and the number of intracranial metastases. We wished to determine whether inclusion of cumulative intracranial tumor volume (CITV) into the ds-GPA model for melanoma augmented its prognostic value. OBJECTIVE To determine whether or not CITV augments the ds-GPA prognostic scale for melanoma. METHODS We analyzed the survival pattern of 344 melanoma patients with BM treated with stereotactic radiosurgery (SRS) at separate institutions and validated our findings in an independent cohort of 201 patients. The prognostic value of ds-GPA for melanoma was quantitatively compared with and without the addition of CITV using the net reclassification index (NRI > 0) and integrated discrimination improvement (IDI) metrics. RESULTS The incorporation of CITV into the melanoma-specific ds-GPA model enhanced its prognostic accuracy. Addition of CITV to the ds-GPA model significantly improved its prognostic value, with NRI > 0 of 0.366 (95% CI: 0.125-0.607, P = .002) and IDI of 0.024 (95% CI: 0.008-0.040, P = .004). We validated these findings that CITV improves the prognostic utility of melanoma ds-GPA in an independent cohort of 201 melanoma cohort. CONCLUSION The prognostic value of the ds-GPA scale for melanoma BM is enhanced by the incorporation of CITV.

scholarly journals BMET-09CUMULATIVE INTRACRANIAL TUMOR VOLUME (CITV) ENHANCES THE PROGNOSTIC VALUE OF THE LUNG-SPECIFIC-GRADED PROGNOSTIC ASSESSMENT (GPA) MODEL

2015 ◽  
Vol 17 (suppl 5) ◽  
pp. v46.4-v46
Author(s):  
Logan Marcus ◽  
Deborah Marshall ◽  
Brandon McCutcheon ◽  
David Gonda ◽  
Steve Goetsch ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Tumor Volume ◽  
Intracranial Tumor ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

Cumulative Intracranial Tumor Volume (CITV) Enhances the Prognostic Value of the Lung-Specific Graded Prognostic Assessment (GPA) Model

Neurosurgery ◽  
2016 ◽  
Vol 79 (2) ◽  
pp. 246-252 ◽  
Author(s):  
Logan P. Marcus ◽  
Deborah Marshall ◽  
Brian R. Hirshman ◽  
Brandon A. McCutcheon ◽  
David D. Gonda ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Tumor Volume ◽  
Intracranial Tumor ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

scholarly journals Validation of the Updated Renal Graded Prognostic Assessment (GPA) for patients with renal cancer brain metastases treated with Gamma Knife radiosurgery

2021 ◽  
Author(s):  
Niels van Ruitenbeek ◽  
Vincent Ho ◽  
Hans Westgeest ◽  
Laurens Beerepoot ◽  
Patrick Hanssens
Keyword(s):  
Brain Metastasis ◽  
Disease Progression ◽  
Gamma Knife ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Gamma Knife Radiosurgery ◽  
Local Failure ◽  
Prognostic Assessment ◽  
Intracranial Disease ◽  
Graded Prognostic Assessment

Abstract Introduction: Prognosis of patients with brain metastasis (BM) from renal cell carcinoma (RCC) is relevant for treatment decisions and can be estimated with the Renal Graded Prognostic Assessment (GPA). The aim of this study is to validate the updated version of this instrument in a cohort treated with Gamma Knife radiosurgery (GKRS) without prior local intracerebral therapy. Methods: Between 2007 and 2018, 100 RCC patients with BM were treated with GKRS. They were categorized according to the updated Renal GPA. Overall survival (OS), intracranial disease progression and intracranial local failure were estimated using the Kaplan-Meier method and risk factors were identified with Cox proportional hazard regressions. Results: Median OS was 10.4 months. Median OS for GPA categories 0.0-1.0 (10%), 1.5-2.0 (13%), 2.5-3.0 (37%) and 3.5-4.0 (31%) was 2.9, 5.5, 8.1 and 20.4 months, respectively. Karnofsky performance status <90, serum hemoglobin ≤12.5 g/dL, age >65 years and time from primary diagnosis to brain metastasis <1 year were significantly related with shorter survival, while presence of extracranial disease, the volume and total number of BM had no impact on OS. A total count of >4 BM was the only predictive factor for intracranial disease progression, while none of the investigated factors predicted intracranial local failure. Conclusions: This study confirms the updated Renal GPA in an independent cohort as a valuable instrument to estimate survival in patients with BM from RCC treated with GKRS.

scholarly journals RADI-13. IMPACT OF CITV AND BRAF MUTATION ON MELANOMA METASTASIS RESPONSE TO STEREOTACTIC RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i24-i24
Author(s):  
Ali Alattar ◽  
Rushikesh Joshi ◽  
Brian HIrshman ◽  
Kate Carroll ◽  
Osamu Nagano ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Braf Mutation ◽  
Proportional Hazards ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Cox Proportional Hazards ◽  
Melanoma Metastasis ◽  
Mutation Status ◽  
Prognostic Assessment ◽  
Independent Cohort

Abstract INTRODUCTION: Survival prognostication is an important aspect of personalizing oncologic care for patients with melanoma brain metastasis (BM). We previous demonstrated the utility of a cumulative intracranial tumor volume modified diagnosis-specific graded prognostic assessment scale (CITV-dsGPA) for SRS-treated melanoma BM patients. Pertinent prognostic variables in this model included age, Karnofsky performance status (KPS), and CITV. Here we determined whether the incorporation of BRAF mutation status into this CITV-modified scale further enhanced its prognostic accuracy. METHODS: We collated the survival pattern of 331 melanoma BM patients with known BRAF mutation status treated with stereotactic radiosurgery (SRS) and validated our findings in an independent cohort of 174 patients. All patients with BRAF mutation were treated with BRAF inhibitors. The prognostic utility of the model with and without BRAF mutation information was compared using the net reclassification index (NRI &gt; 0) and integrated discrimination improvement (IDI) metric. RESULTS: Presence of the BRAF mutation was associated with a reduced hazard of death in univariate Cox proportional hazards survival analysis (hazard ratio (HR) 0.74, p&lt; 0.001). This effect persisted in a multivariate model that controlled for age, KPS, and CITV (HR 0.72, p&lt; 0.001). Addition of BRAF mutation status to the CITV-ds-GPA model for melanoma significantly improved its prognostic value, with NRI &gt;0 of 0.294 (p=0.01) and IDI of 0.017 (p=0.02). We validated these findings in an independent cohort of 174 melanoma patients. CONCLUSIONS: Optimal survival prognostication for SRS-treated patients with melanoma BM requires an integrated assessment of age, KPS, CITV, and BRAF mutation status.

scholarly journals CMET-45. USING CUMULATIVE INTRACRANIAL TUMOR VOLUME AS A PROGNOSTIC FACTOR IN THE GI-SPECIFIC GRADED PROGNOSTIC ASSESSMENT (GPA) MODEL

2017 ◽  
Vol 19 (suppl_6) ◽  
pp. vi48-vi49
Author(s):  
Rushikesh Joshi ◽  
Brian Hirshman ◽  
Mir Amaan Ali ◽  
Kate Carroll ◽  
Bayard Wilson ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Tumor Volume ◽  
Intracranial Tumor ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

scholarly journals Prognostic factors in glioblastoma multiforme

2010 ◽  
Vol 29 (04) ◽  
pp. 121-125 ◽  
Author(s):  
Leonardo Welling ◽  
José Carlos Lynch ◽  
Celestino Pereira ◽  
Ricardo Andrade ◽  
Fabiana Polycarpo Hidalgo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Glioblastoma Multiforme ◽  
Retrospective Analysis ◽  
Tumor Volume ◽  
Standard Treatment ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Surgical Techniques ◽  
The Other ◽  
Tumor Removal

Abstract Objective: To study if the prognosis variables such as age, the Karnofsky Performance Status (KPS), extension of tumor removal by surgery, radiotherapy and tumor volume influenced the survival of patients with glioblastoma multiforme (GBM). Method: Retrospective analysis of GBM patients operated at Hospital dos Servidores do Estado between 1998 and 2008. Results: We could observe that age, the KPS and radiotherapy influenced the survival. The other variables did not have any prognosis implications. Conclusions: Despite many researches and many improvements regarding the diagnosis and the surgical techniques, the survival of patients with GBM has not changed in the last 30 years and is a therapeutic challenge. The surgical resection followed by radiotherapy is the standard treatment for patients with GBM. The importance of each variable in the patient's prognosis is still to be established in the multivariate analyzes.

The prognostic value of polymorphisms in the insulin-like growth factor receptor (IGFR) pathway in patients with locally advanced pancreatic cancer (LAPC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4500-4500
Author(s):  
R. T. Shroff ◽  
M. M. Javle ◽  
X. Dong ◽  
V. S. Kumar ◽  
S. Krishnan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Induction Chemotherapy ◽  
Prognostic Value ◽  
Cox Regression ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Rank Test ◽  
Cox Regression Analysis

4500 Background: The IGFR pathway is activated in pancreatic cancer and may result in aggressive disease course. The study of single nucleotide polymorphisms (SNPs) involved in this pathway may provide prognostic information and predict response to IGFR directed agents. We investigated IGFR pathway SNPs in patients with LAPC. Methods: We evaluated 39 SNPs from 7 candidate genes in the IGFR pathway (IGF1R, IGF2R, IGF1, IGF2, IRS1, IRS2, IGFBP3) in 105 LAPC patients. DNA extraction from whole blood was performed using the Qiagen Flexigene DNA and Promega Maxwell 16 kits. Genotyping was performed using the Sequenom method. Overall survival was measured from date of diagnosis to date of death or last follow-up. Kaplan-Meier plot, log-rank test, and Cox regression were used to compare survival of patients according to genotype corrected for previously identified prognostic factors, including induction chemotherapy, CA 19–9, albumin, LDH, hemoglobin and Karnofsky performance status (KPS). Results: Median survival time (MST) was 15 months (95% CI 13.3–16.7). Induction chemotherapy, LDH, CA 19–9 level, hemoglobin, and KPS were not significantly associated with survival. Serum albumin and three SNPs of the IGF pathway (IGF1R IVS20–3431A>G, IRS1 G971R, and IGF2 *4352A>G) were significantly associated with prognosis ( Table ). Two of the three genotypes remained as significant predictors for survival in Cox regression analysis when adjusted for clinical factors. A significant combined genotype effect was observed wherein patients with all three deleterious alleles had significantly worse survival than those with only two or one (10 vs. 16.3 vs. 21.3 months, p< 0.0001). Conclusions: These data suggest that SNPs in the IGFR pathway genes may have prognostic value for LAPC patients. This information may identify population subgroups that could benefit from IGFR-targeted agents. [Table: see text] No significant financial relationships to disclose.

scholarly journals Volumetric modulated arc radiosurgery for brain metastases from breast cancer: A single-center study

2021 ◽  
Vol 52 (3) ◽  
pp. e2004567
Author(s):  
José Manuel Sánchez-Villalobos ◽  
Alfredo Serna-Berna ◽  
Juan Salinas-Ramos ◽  
Pedro Pablo Escolar-Pérez ◽  
Emma Martínez-Alonso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Molecular Subtype ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Volumetric Modulated Arc Therapy ◽  
Treatment Modalities ◽  
Her2 Status ◽  
Prognostic Assessment ◽  
Whole Brain Radiation

Background: Whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) are two treatment modalities commonly utilized to treat brain metastases (BMs). Aim: The purpose of this study is to analyze retrospectively the local control and survival of patients with BMs of breast cancer (BC) treated via radiosurgery using Volumetric Modulated Arc Therapy (VMAT-RS). Methods: 18 patients with 41 BMs of BC and treated by VMAT-RS were studied. They were classified according to the molecular subtype of BC and the modified breast graded prognostic assessment -GPA- index. Patients presented 1-4 BMs, which were treated with 5 non-coplanar VMAT arcs. The spatial distribution of BMs, the influence of receptor status on the location of the lesions and survival assessed via the Kaplan-Meier model were analyzed. Results: The median survival time (MST) was 19.7 months. Statistically significant differences were determined in the MST according to the Karnofsky performance status (p= 0.02) and the HER2 status (p= 0.004), being more prolonged in the HER2+ patients. Finally, our results showed that the cerebellum is the predominant site of breast cancer BMs, and also suggested that HER2+BMs had a predilection for some structures of the posterior circulation, such as the cerebellum, brainstem and occipital lobes (p= 0.048). Conclusions: The VMAT-RS is a technique with an overall survival compared to other radiosurgery techniques. The baseline situation at the time of treatment, the modified breast-GPA and the molecular subtypes are factors that significantly influence patient survival.

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