Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study

Simple Summary To optimize surveillance for patients with brain metastases following stereotactic radiosurgery (SRS), we sought to validate a previously published nomogram estimating post-SRS intracranial progression (IP) risk. Among 890 patients completing an initial SRS course across two institutions 7/2017-12/2020, 53% were deemed high-risk for IP. Freedom from IP was superior for low-risk patients (p < 0.001), with a median of 13.9 months (95% CI 11.1-17.1 months) versus 7.6 months (95% CI 6.4-9.3 months) for high-risk patients. This large multisite cohort supports the use of an IP nomogram as a quick, simple means of stratifying patients into low- and high-risk groups for post-SRS IP. Stereotactic radiosurgery (SRS) is a standard of care for many patients with brain metastases. To optimize post-SRS surveillance, this study aimed to validate a previously published nomogram predicting post-SRS intracranial progression (IP). We identified consecutive patients completing an initial course of SRS across two institutions between July 2017 and December 2020. Patients were classified as low- or high-risk for post-SRS IP per a previously published nomogram. Overall survival (OS) and freedom from IP (FFIP) were assessed via the Kaplan-Meier method. Assessment of parameters impacting FFIP was performed with univariable and multivariable Cox proportional hazard models. Among 890 patients, median follow-up was 9.8 months (95% CI 9.1-11.2 months). In total, 47% had NSCLC primary tumors, and 47% had oligometastatic disease (defined as <= 5 metastastic foci) at the time of SRS. Per the IP nomogram, 53% of patients were deemed high-risk. For low- and high-risk patients, median FFIP was 13.9 months (95% CI 11.1-17.1 months) and 7.6 months (95% CI 6.4-9.3 months), respectively, and FFIP was superior in low-risk patients (p < 0.0001). This large multisite BM cohort supports the use of an IP nomogram as a quick and simple means of stratifying patients into low- and high-risk groups for post-SRS IP.

Automated summary

This study validates a previously published nomogram for predicting intracranial progression risk after stereotactic radiosurgery (SRS) in patients with brain metastases. The nomogram successfully stratifies patients into low- and high-risk groups for post-SRS intracranial progression. The results support the use of this nomogram as a quick and simple tool for surveillance and risk stratification in SRS-treated patients.