Development and Internal Validation of a Recursive Partitioning Analysis–Based Model Predictive of Pain Flare Incidence After Spine Stereotactic Body Radiation Therapy

Kowalchuk, Roman O.; Mullikin, T.C.; Harmsen, William S.; Rose, Peter S.; Siontis, Brittany L.; Kim, Dong Kun; Costello, Brian A.; Morris, Jonathan M.; Marion, Joseph; Johnson-Tesch, Benjamin A; Gao, Robert W.; Shiraishi, S.; Lucido, J.; Olivier, Kenneth R.; Owen, Dawn; Stish, Bradley J.; Laack, Nadia N.; Park, Sean S.; Brown, Paul D.; Merrell, Kenneth W.

doi:10.1016/j.prro.2022.01.011

Cited by 10 publications

(7 citation statements)

References 43 publications

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“…RPA was utilized in an effort to develop a CPTTB risk score predictive of major CPTTB. This approach incorporated decision-tree analysis, and this methodology has been previously utilized and published ( 23 – 25 ). RPA was conducted in Python (v3.8.0) using open-source packages ( 26 – 28 ).…”

Section: Methodsmentioning

confidence: 99%

Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer

et al. 2023

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Purpose/objectivePostoperative toxicity for esophageal cancer impacts patient quality of life and potentially overall survival (OS). We studied whether patient and toxicity parameters post-chemoradiation therapy predict for post-surgical cardiopulmonary total toxicity burden (CPTTB) and whether CPTTB was associated with short and long-term outcomes.Materials/methodsPatients had biopsy-proven esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. CPTTB was derived from total perioperative toxicity burden (Lin et al. JCO 2020). To develop a CPTTB risk score predictive for major CPTTB, recursive partitioning analysis was used.ResultsFrom 3 institutions, 571 patients were included. Patients were treated with 3D (37%), IMRT (44%), and proton therapy (19%). 61 patients had major CPTTB (score ≥ 70). Increasing CPTTB was predictive of decreased OS (p<0.001), lengthier post-esophagectomy length of stay (LOS, p<0.001), and death or readmission within 60 days of surgery (DR60, p<0.001). Major CPTTB was also predictive of decreased OS (hazard ratio = 1.70, 95% confidence interval: 1.17-2.47, p=0.005). The RPA-based risk score included: age ≥ 65, grade ≥ 2 nausea or esophagitis attributed to chemoradiation, and grade ≥ 3 hematologic toxicity attributed to chemoradiation. Patients treated with 3D radiotherapy had inferior OS (p=0.010) and increased major CPTTB (18.5% vs. 6.1%, p<0.001).ConclusionCPTTB predicts for OS, LOS, and DR60. Patients with 3D radiotherapy or age ≥ 65 years and chemoradiation toxicity are at highest risk for major CPTTB, predicting for higher short and long-term morbidity and mortality. Strategies to optimize medical management and reduce toxicity from chemoradiation should be strongly considered.

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Section: Methodsmentioning

confidence: 99%

Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer

et al. 2023

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“…Recursive partitioning analysis (RPA) was performed with decision‐tree analysis in accordance with prior literature 26,27,36 . Scripts were developed in Python (v3.8.0) through the use of multiple open‐source packages 37–39 .…”

Section: Methodsmentioning

confidence: 99%

“…Recursive partitioning analysis (RPA) was performed with decisiontree analysis in accordance with prior literature. 26,27,36 Scripts were developed in Python (v3.8.0) through the use of multiple open-source packages. [37][38][39] Censoring of the data for death was included,<zaq;9> and the log-rank test was used as the criterion for node splitting.…”

Section: Recursive Partitioning Analysismentioning

confidence: 99%

“…Optimizing patient selection for spine SBRT is vital for maximizing the therapeutic benefit, minimizing toxicity, and offering cost‐effective care. Important potential side effects include pain flares and vertebral compression fracture 26,27 . Furthermore, multiple studies have concluded that spine SBRT is a cost‐effective treatment for patients with favorable OS, but it may not be cost‐effective for patients with poor OS 28–32 …”

Section: Introductionmentioning

confidence: 99%

“…Important potential side effects include pain flares and vertebral compression fracture. 26,27 Furthermore, multiple studies have concluded that spine SBRT is a cost-effective treatment for patients with favorable OS, but it may not be cost-effective for patients with poor OS. [28][29][30][31][32] We aim to contribute to the literature by using a large database to develop a novel OS classification.…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of a recursive partitioning analysis–based pretreatment decision‐making tool identifying ideal candidates for spine stereotactic body radiation therapy

Kowalchuk

Mullikin

Florez

et al. 2022

Cancer

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Background This study was aimed at developing and validating a decision‐making tool predictive of overall survival (OS) for patients receiving stereotactic body radiation therapy (SBRT) for spinal metastases. Methods Three hundred sixty‐one patients at one institution were used for the training set, and 182 at a second institution were used for external validation. Treatments most commonly involved one or three fractions of spine SBRT. Exclusion criteria included proton therapy and benign histologies. Results The final model consisted of the following variables and scores: Spinal Instability Neoplastic Score (SINS) ≥ 6 (1), time from primary diagnosis < 21 months (1), Eastern Cooperative Oncology Group (ECOG) performance status = 1 (1) or ECOG performance status > 1 (2), and >1 organ system involved (1). Each variable was an independent predictor of OS (p < .001), and each 1‐point increase in the score was associated with a hazard ratio of 2.01 (95% confidence interval [CI], 1.79–2.25; p < .0001). The concordance value was 0.75 (95% CI, 0.71–0.78). The scores were discretized into three groups—favorable (score = 0–1), intermediate (score = 2), and poor survival (score = 3–5)—with 2‐year OS rates of 84% (95% CI, 79%–90%), 46% (95% CI, 36%–59%), and 21% (95% CI, 14%–32%), respectively (p < .0001 for each). In the external validation set (182 patients), the score was also predictive of OS (p < .0001). Increasing SINS was predictive of decreased OS as a continuous variable (p < .0001). Conclusions This novel score is proposed as a decision‐making tool to help to optimize patient selection for spine SBRT. SINS may be an independent predictor of OS.

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Long‐term follow‐up results of spine tumor treatment using high‐dose radiotherapy after 3‐dimensional‐printed vertebral bodies implantation

et al. 2023

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Objective: To investigate the long-term safety and efficacy of high-dose radiotherapy after 3D-printed vertebral body implantation in the treatment of spinal tumors. Methods: Thirty-three participants were recruited between July 2017 and August 2019. 3D-printed vertebral bodies were implanted in each participant, followed by postoperative robotic stereotactic radiosurgery at a dose of 35-40 Gy/5f. The tolerance of the 3D-printed vertebral body and the participant to the high-dose radiotherapy were evaluated. In addition, the local control of tumor and the local progression-free survival of the study participants following 3D-printed vertebral body implantation and high-dose radiotherapy were measured as indexes of effectiveness.Results: Of the 33 participants included in the study, 30, including three participants (10%) with esophagitis of grade 3 or above and two participants (6.7%) with advanced radiation nerve injury, successfully underwent postoperative high-dose radiotherapy. The median follow-up was 26.7 months, and IQR was 15.9 months.Most participants had primary bone tumors with 27 cases (81.8%), and the rest had bone metastases in six cases (18.2%). After high-dose radiotherapy, the 3Dprinted vertebrae maintained good vertebral stability and exhibited histocompatibility, without implant fractures. The local control rates were 100%, 88%, and 85% 6 months, 1 year, and 2 years after high-dose radiotherapy, respectively. Tumors recurred in four participants (12.1%) during the follow-up period. The median local progression-free survival after treatment was 25.7 months, with a range of 9.6-33.0 months. Conclusion:High-dose radiotherapy for spinal tumors after 3D-printed vertebral body implantation is feasible, elicits low toxicity, and yields satisfactory tumor control.

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Development and Internal Validation of a Recursive Partitioning Analysis–Based Model Predictive of Pain Flare Incidence After Spine Stereotactic Body Radiation Therapy

Cited by 10 publications

References 43 publications

Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer

Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer

Development and validation of a recursive partitioning analysis–based pretreatment decision‐making tool identifying ideal candidates for spine stereotactic body radiation therapy

Long‐term follow‐up results of spine tumor treatment using high‐dose radiotherapy after 3‐dimensional‐printed vertebral bodies implantation

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