D D Gonda1, T E Kim1, S J Goetsch2, T Kawabe3, S Watanabe4, J F Alksne1, J A Hattangadi5, M Nitta6, K Ott2, D W Hodgens2, B S Carter1, M Yamamoto7, Clark C Chen8. 1. Center for Translational and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego, USA. 2. San Diego Gamma Knife Center, San Diego, USA. 3. Katsuta Hospital Mito GammaHouse, 5125-2 Nakane, Hitachi-naka 312-0011, Japan; Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Sciences, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. 4. Katsuta Hospital Mito GammaHouse, 5125-2 Nakane, Hitachi-naka 312-0011, Japan; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan. 5. Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, 8-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan. 6. Department of Radiation Oncology, University of California, San Diego, USA. 7. San Diego Gamma Knife Center, San Diego, USA; Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, 8-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan. 8. Center for Translational and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego, USA. Electronic address: clarkchen@ucsd.edu.
Abstract
INTRODUCTION: Defining key prognostic factors for patients with cerebral metastases who underwent stereotactic radiosurgery (SRS) treatment will greatly facilitate future clinical trial designs. METHODS: We adopted a two-phase study design where results from one cohort were validated in a second independent cohort. The exploratory analysis reviewed the survival outcomes of 1017 consecutive patients (with 3610 metastases) who underwent Gamma radiosurgery at the University of California, San Diego (UCSD)/San Diego Gamma Knife Center (SDGKC). Multivariate analysis was performed to identify prognostic factors. Results were validated using data derived from 2519 consecutive patients (with 17,498 metastases) treated with SRS at the Katsuta Hospital. RESULTS: For the SDGKC cohort, the median overall survival of patients following SRS was 7 months. Two year follow-up data were available for 85% of the patients. Multivariate analysis found that patient age, Karnofsky Performance Status, systemic cancer status, tumour histology, number of metastasis and cumulative tumour volume independently associated with overall survival (p<0.001). All statistical associations were validated by multivariate analysis of data derived from the Katsuta Hospital cohort. CONCLUSIONS: This is the first integrated study that defined prognostic factors for SRS-treated patients with cerebral metastases using an inter-institutional validation study design. The work establishes a model for collaborative interactions between large volume centers and provides prognostic variables that should be incorporated into future clinical trial design.
INTRODUCTION: Defining key prognostic factors for patients with cerebral metastases who underwent stereotactic radiosurgery (SRS) treatment will greatly facilitate future clinical trial designs. METHODS: We adopted a two-phase study design where results from one cohort were validated in a second independent cohort. The exploratory analysis reviewed the survival outcomes of 1017 consecutive patients (with 3610 metastases) who underwent Gamma radiosurgery at the University of California, San Diego (UCSD)/San Diego Gamma Knife Center (SDGKC). Multivariate analysis was performed to identify prognostic factors. Results were validated using data derived from 2519 consecutive patients (with 17,498 metastases) treated with SRS at the Katsuta Hospital. RESULTS: For the SDGKC cohort, the median overall survival of patients following SRS was 7 months. Two year follow-up data were available for 85% of the patients. Multivariate analysis found that patient age, Karnofsky Performance Status, systemic cancer status, tumour histology, number of metastasis and cumulative tumour volume independently associated with overall survival (p<0.001). All statistical associations were validated by multivariate analysis of data derived from the Katsuta Hospital cohort. CONCLUSIONS: This is the first integrated study that defined prognostic factors for SRS-treated patients with cerebral metastases using an inter-institutional validation study design. The work establishes a model for collaborative interactions between large volume centers and provides prognostic variables that should be incorporated into future clinical trial design.
Authors: Mir Amaan Ali; Brian R Hirshman; Bayard Wilson; Alexander J Schupper; Rushikesh Joshi; James A Proudfoot; Steven J Goetsch; John F Alksne; Kenneth Ott; Hitoshi Aiyama; Osamu Nagano; Bob S Carter; Veronica Chiang; Toru Serizawa; Masaaki Yamamoto; Clark C Chen Journal: World Neurosurg Date: 2017-07-25 Impact factor: 2.104
Authors: Brian R Hirshman; Bayard Wilson; Mir Amaan Ali; James A Proudfoot; Takao Koiso; Osamu Nagano; Bob S Carter; Toru Serizawa; Masaaki Yamamoto; Clark C Chen Journal: Neurosurgery Date: 2018-04-01 Impact factor: 4.654
Authors: Deborah C Marshall; Logan P Marcus; Teddy E Kim; Brandon A McCutcheon; Steven J Goetsch; Takao Koiso; John F Alksne; Kenneth Ott; Bob S Carter; Jona A Hattangadi-Gluth; Masaaki Yamamoto; Clark C Chen Journal: J Neurooncol Date: 2016-03-07 Impact factor: 4.130
Authors: Manmeet Ahluwalia; Mir A Ali; Rushikesh S Joshi; Eun Suk Park; Birra Taha; Ian McCutcheon; Veronica Chiang; Angela Hong; Georges Sinclair; Jiri Bartek; Clark C Chen Journal: Neurooncol Adv Date: 2020-11-12