
==== Front
Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.065
vdae090.065
Final Category: Neuroimaging/Radiologic Advances
AcademicSubjects/MED00300
AcademicSubjects/MED00310
NIRL-04 BRAIN METASTASES DISTRIBUTION WIDTH (BMDW): A NOVEL METRIC TO PREDICT DISTANT BRAIN FAILURE FOLLOWING STEREOTACTIC RADIOSURGERY IN PATIENTS WITH MULTIPLE BRAIN METASTASES
Gal Omer Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Yarlagadda Sreenija Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Hall Matthew D Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Press Robert H Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Wieczorek D Jay Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Lee Yongsook C Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Bejarano Tatiana Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Tolakanahalli Ranjini Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Gutierrez Alonso N Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

McDermott Michael W Miami Neuroscience Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Mehta Minesh P Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Kotecha Rupesh Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i20i21
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

INTRODUCTION

We introduce a method of predicting clinical outcomes in newly diagnosed brain metastases (BM) patients after upfront stereotactic radiosurgery (SRS), based on a novel metric - brain metastases distribution width (BMDW) – which measures the amount of variation in BM volume.

METHODS

BMDW was defined as the coefficient of variation of mean BM volume (mBMV) per patient and was calculated by dividing the standard deviation of the mBMV (SD-mBMV) by the mBMV and multiplying by 100, to yield a percentage value representing BM volume heterogeneity. Patients were classified by BMDW into low (≤100) and high (>100) risk groups and the distant brain failure (DBF)-free and overall survival (OS) outcomes were summarized using the Kaplan-Meier method and compared between the two risk groups using the log-rank test.

RESULTS

The study cohort included 99 patients, the median age was 67 years (Range: 18-88) and 51% were female. The high- and low-risk groups included 63 (64%) and 36 (36%) patients, respectively. At a median follow-up of 20 months, a low BMDW predicted for a statistically significant prolonged DBF-free survival with a median of 21.4 months (95% confidence interval [CI]: 8.7-34.1 months) versus 4.9 months (95% CI: 3.3-6.5 months) for the high-risk group (p=0.023). OS was not significantly different between the groups (p=0.159). Multivariate analysis showed that BMDW was a dominant predictor of DBF, with a hazard ratio (HR) of 2.45 for the high-risk group (95% CI: 1.26-4.77, p=0.008), in addition to performance status (HR=2.16, 95% CI: 1.29-3.62, p=0.003) and presence of >10 lesions at diagnosis (HR=1.95, 95% CI: 1.01-3.77, p=0.046).

CONCLUSIONS

BMDW is a novel predictor of DBF in this cohort of newly diagnosed lung cancer patients with multiple brain metastases. It may be considered as a metric for patient selection between SRS and alternative options, such as hippocampal-avoidance whole brain radiotherapy.
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