title: Novel risk scores for survival and intracranial failure in patients treated with radiosurgery alone to melanoma brain metastases.
abstract: OBJECTIVE
  Stereotactic radiosurgery (SRS) alone is an increasingly common treatment strategy for brain metastases. However, existing prognostic tools for overall survival (OS) were developed using cohorts of patients treated predominantly with approaches other than SRS alone. Therefore, we devised novel risk scores for OS and distant brain failure (DF) for melanoma brain metastases (MBM) treated with SRS alone.
  
  
  METHODS
  We retrospectively reviewed 86 patients treated with SRS alone for MBM from 2009-2014. OS and DF were estimated using the Kaplan-Meier method. Cox proportional hazards modeling identified clinical risk factors. Risk scores were created based on weighted regression coefficients. OS scores range from 0-10 (0 representing best OS), and DF risk scores range from 0-5 (0 representing lowest risk of DF). Predictive power was evaluated using c-index statistics. Bootstrapping with 200 resamples tested model stability.
  
  
  RESULTS
  The median OS was 8.1 months from SRS, and 54 (70.1 %) patients had DF at a median of 3.3 months. Risk scores for OS were predicated on performance status, extracranial disease (ED) status, number of lesions, and gender. Median OS for the low-risk group (0-3 points) was not reached. For the moderate-risk (4-6 points) and high-risk (6.5-10) groups, median OS was 7.6 months and 2.4 months, respectively (p < .0001). Scores for DF were predicated on performance status, ED status, and number of lesions. Median time to DF for the low-risk group (0 points) was not reached. For the moderate-risk (1-2 points) and high-risk (3-5 points) groups, time to DF was 4.8 and 2.0 months, respectively (p < .0001). The novel scores were more predictive (c-index = 0.72) than melanoma-specific graded prognostic assessment or RTOG recursive partitioning analysis tools (c-index = 0.66 and 0.57, respectively).
  
  
  CONCLUSIONS
  We devised novel risk scores for MBM treated with SRS alone. These scores have implications for prognosis and treatment strategy selection (SRS versus whole-brain radiotherapy).
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. Imran.Chowdhury@uphs.upenn.edu.
authors.forename: Imran H
authors.initials: IH
authors.lastname: Chowdhury
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. Eric.Ojerholm@uphs.upenn.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Ojerholm
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, 19104, PA, USA. Matthew.Mcmillan@uphs.upenn.edu.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: McMillan
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA. Denise.Miller2@uphs.upenn.edu.
authors.forename: Denise
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. James.Kolker@uphs.upenn.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: Kolker
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. Goldie.Kurtz@uphs.upenn.edu.
authors.forename: Goldie
authors.initials: G
authors.lastname: Kurtz
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. Jay.Dorsey2@uphs.upenn.edu.
authors.forename: Jay F
authors.initials: JF
authors.lastname: Dorsey
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. Suneel.Nagda@uphs.upenn.edu.
authors.forename: Suneel N
authors.initials: SN
authors.lastname: Nagda
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. Geoffrey.Geiger@uphs.upenn.edu.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Geiger
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA. Steven.Brem@uphs.upenn.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Brem
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA. orourked@mail.med.upenn.edu.
authors.forename: Donald M
authors.initials: DM
authors.lastname: O'Rourke
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA. Eric.Zager@uphs.upenn.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Zager
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104, PA, USA. Tara.Gangadhar@uphs.upenn.edu.
authors.forename: Tara
authors.initials: T
authors.lastname: Gangadhar
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104, PA, USA. Lynn.Schuchter@uphs.upenn.edu.
authors.forename: Lynn
authors.initials: L
authors.lastname: Schuchter
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street - 3 Silverstein, Philadelphia, 19104, PA, USA. John.Lee3@uphs.upenn.edu.
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard - TRC 2 West, Philadelphia, 19104, PA, USA. Michelle.Alonso-Basanta@uphs.upenn.edu.
authors.forename: Michelle
authors.initials: M
authors.lastname: Alonso-Basanta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult