Development and validation of a unifying pre-treatment decision tool for intracranial and extracranial metastasis-directed radiotherapy.

dc.contributor.author

Kowalchuk, Roman

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Mullikin, Trey C

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Breen, William

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Gits, Hunter C

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Florez, Marcus

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De, Brian

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Harmsen, William S

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Rose, Peter Sean

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Siontis, Brittany L

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Costello, Brian A

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Morris, Jonathan M

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Lucido, John J

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Olivier, Kenneth R

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Stish, Brad

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Laack, Nadia N

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Park, Sean

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Owen, Dawn

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Ghia, Amol J

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Brown, Paul D

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Merrell, Kenneth Wing

dc.date.accessioned

2023-05-01T14:59:50Z

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2023-05-01T14:59:50Z

dc.date.issued

2023-01

dc.date.updated

2023-05-01T14:59:48Z

dc.description.abstract

Background

Though metastasis-directed therapy (MDT) has the potential to improve overall survival (OS), appropriate patient selection remains challenging. We aimed to develop a model predictive of OS to refine patient selection for clinical trials and MDT.

Patients and methods

We assembled a multi-institutional cohort of patients treated with MDT (stereotactic body radiation therapy, radiosurgery, and whole brain radiation therapy). Candidate variables for recursive partitioning analysis were selected per prior studies: ECOG performance status, time from primary diagnosis, number of additional non-target organ systems involved (NOS), and intracranial metastases.

Results

A database of 1,362 patients was assembled with 424 intracranial, 352 lung, and 607 spinal treatments (n=1,383). Treatments were split into training (TC) (70%, n=968) and internal validation (IVC) (30%, n=415) cohorts. The TC had median ECOG of 0 (interquartile range [IQR]: 0-1), NOS of 1 (IQR: 0-1), and OS of 18 months (IQR: 7-35). The resulting model components and weights were: ECOG = 0, 1, and > 1 (0, 1, and 2); 0, 1, and > 1 NOS (0, 1, and 2); and intracranial target (2), with lower scores indicating more favorable OS. The model demonstrated high concordance in the TC (0.72) and IVC (0.72). The score also demonstrated high concordance for each target site (spine, brain, and lung).

Conclusion

This pre-treatment decision tool represents a unifying model for both intracranial and extracranial disease and identifies patients with the longest survival after MDT who may benefit most from aggressive local therapy. Carefully selected patients may benefit from MDT even in the presence of intracranial disease, and this model may help guide patient selection for MDT.
dc.identifier.issn

2234-943X

dc.identifier.issn

2234-943X

dc.identifier.uri

https://hdl.handle.net/10161/27272

dc.language

eng

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Frontiers Media SA

dc.relation.ispartof

Frontiers in oncology

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10.3389/fonc.2023.1095170

dc.subject

metastasis-directed radiotherapy

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metastatic disease

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modeling

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oligometastasis

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outcomes

dc.title

Development and validation of a unifying pre-treatment decision tool for intracranial and extracranial metastasis-directed radiotherapy.

dc.type

Journal article

duke.contributor.orcid

Mullikin, Trey C|0000-0002-1099-1763

pubs.begin-page

1095170

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Institutes and Centers

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Radiation Oncology

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Duke Cancer Institute

pubs.publication-status

Published

pubs.volume

13

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