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

Marcus, Logan P.; Marshall, Deborah; Hirshman, Brian R.; McCutcheon, Brandon A.; Gonda, David; Koiso, Takao; Hattangadi‐Gluth, Jona A.; Carter, Bob S.; Yamamoto, Masaaki; Chen, Clark C.

doi:10.1227/neu.0000000000001123

Cited by 23 publications

(23 citation statements)

References 23 publications

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“…We previously examined the optimal CITV cut-off for survival prognostication in SRS-treated lung cancer patients and found 4 cc’s to be the optimal cut-off [8]. We wished to determine whether this CITV cut-off is applicable to RCC patients.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, if there is significant variability in tumor volume between different BM, then the correlation between these variables would be expected to be poor, as we reported to be the case in lung cancer. [8] The correlation between the number of BM and CITV suggests that RCC BM tend to be more homogenous in tumor volume relative to lung BM.…”

Section: Discussionmentioning

confidence: 99%

“…CITV was defined as the cumulative volume of all treated lesions. [8, 9, 11] We used Elekta's Gamma Plan software on a pre-SRS T1-weighted post-contrast image to calculate this sum tumor volume. Patients who underwent multiple SRS were included as a single entry in the database, with age, KPS, and CITV collected at this time point.…”

Section: Methodsmentioning

confidence: 99%

“…[7] The scale suggests that survival prognostication for RCC patients with BM is reliant on two clinical variables: Karnofsky’s Performance Score (KPS) and the number of BM. [7] Our previous work suggests that the Cumulative Intracranial Tumor Volume (CITV) of BM, defined as the sum volume of all intracranial metastases at the time of presentation, served as a strong prognostic factor for lung cancer patients afflicted with BM [8–10]. However, since the fundamental premise of dsGPA is that prognostic factors critical for each cancer type differ, it remains unclear whether CITV serve as an important prognostic factor in the context of RCC dsGPA.…”

Section: Introductionmentioning

confidence: 99%

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Improving the Prognostic Value of Disease-Specific Graded Prognostic Assessment Model for Renal Cell Carcinoma by Incorporation of Cumulative Intracranial Tumor Volume

et al. 2017

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Background We tested the prognostic value of cumulative intracranial tumor volume (CITV) in the context of ds-GPA model for renal cell carcinoma (RCC) patients with brain metastasis (BM) treated with stereotactic radiosurgery (SRS). Methods Patient and tumor characteristics were collected from RCC cohorts with newly BM who underwent SRS. Univariable and multivariable logistic regression model was used to test the prognostic value of CITV, Karnofsky Performance Score (KPS), and the number of BM. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to assess whether CITV improved the prognostic utility of RCC ds-GPA. Results In univariable logistic regression models, CITV, KPS, and the number of BM independently associated with RCC patient survival. In a multivariable Cox proportional hazard model, the association between CITV and survival remained robust after controlling for KPS and the number of BM (P=.042). The incorporation of the cumulative intracranial tumor volume (CITV) into the RCC ds-GPA model (consisting of KPS and number of BM) improved prognostic accuracy with NRI>0 of 0.3156 (95% CI: 0.0883–0.5428, P=.0065) and integrated discrimination improvement (IDI) of 0.0151 (95% CI: 0.0036–0.0277, P=.0183). These findings were validated in an independent cohort of 107 SRS-treated RCC BM patients. Conclusion CITV is an important prognostic variable in SRS-treated RCC patients with BM. The prognostic value of the ds-GPA scale for RCC brain metastasis was enhanced by the incorporation of CITV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving the Prognostic Value of Disease-Specific Graded Prognostic Assessment Model for Renal Cell Carcinoma by Incorporation of Cumulative Intracranial Tumor Volume

et al. 2017

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“…Radiosurgery was performed as previously described 19,20 . In brief, patients underwent Magnetic Resonance Imaging (MRI) of the brain with either the Toshiba America Medical Systems MRI machine (Tustin, California) at 2 mm slices or the GE Healthcare MRI machine (Milwaukee, Wisconsin) using 1 mm slices in conjunction with the Leksell stereotactic head frame.…”

Section: Methodsmentioning

confidence: 99%

Survival Patterns of 5750 Stereotactic Radiosurgery–Treated Patients with Brain Metastasis as a Function of the Number of Lesions

et al. 2017

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Background The number of brain metastases (BM) plays an important role in the decision between stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT). Methods We analyzed the survival of 5750 SRS-treated BM patients as a function of BM number. Survival analyses were performed using Kaplan-Meier analysis as well as univariate and multivariate Cox proportional hazards models. Results BM patients were first categorized as those with 1, 2–4, and 5–10 BM based on the scheme proposed by Yamamoto et al (Lancet Oncology 2014). Median overall survival for patients with 1 BM was superior to those with 2–4 BMs (7.1 mo v. 6.4 mo, p=0.009), and survival of patients with 2–4 BMs did not differ from those with 5–10 BMs (6.4 mo v. 6.3 mo, p=0.170). The median survival of patients with >10 BMs was lower than those with 2–10 BMs (6.3 mo v. 5.5 mo, p=0.025). In a multivariate model that accounted for age, Karnofsky Performance Score (KPS), systemic disease status, tumor histology, and cumulative intracranial tumor volume (CITV), we observed a ~10% increase in hazard of death when comparing patients with 1 versus 2–10 BM (p<0.001) or 10 versus >10 BM (p<0.001). When BM number was modeled as a continuous variable rather than using the Yamamoto classification, we observed a step-wise 5% increase in the hazard of death for every increment of 5–6 BM (p<0.001). Conclusions The contribution of BM number to overall survival is modest, and should be considered as one of the many variables considered in the decision between SRS and WBRT.

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Cumulative Intracranial Tumor Volume as a Prognostic Factor in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery

Hirshman

Compton

Carroll

et al. 2021

Acta Neurochirurgica Supplement

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

Cited by 23 publications

References 23 publications

Improving the Prognostic Value of Disease-Specific Graded Prognostic Assessment Model for Renal Cell Carcinoma by Incorporation of Cumulative Intracranial Tumor Volume

Improving the Prognostic Value of Disease-Specific Graded Prognostic Assessment Model for Renal Cell Carcinoma by Incorporation of Cumulative Intracranial Tumor Volume

Survival Patterns of 5750 Stereotactic Radiosurgery–Treated Patients with Brain Metastasis as a Function of the Number of Lesions

Cumulative Intracranial Tumor Volume as a Prognostic Factor in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery

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