Nomogram based overall survival prediction in stereotactic body radiotherapy for oligo-metastatic lung disease.
Radical local treatment of pulmonary metastases is practiced with increasing frequency due to acknowledgment and better understanding of oligo-metastatic disease. This study aimed to develop a nomogram predicting overall survival (OS) after stereotactic body radiotherapy (SBRT) for pulmonary metastases.



A multi-institutional database of 670 patients treated with SBRT for pulmonary metastases was used as training cohort. Cox regression analysis with bidirectional variable elimination was performed to identify factors to be included into the nomogram model to predict 2-year OS. The calibration rate of the nomogram was assessed by plotting the actual Kaplan-Meier 2-year OS against the nomogram predicted survival. The nomogram was externally validated using two separate monocentric databases of 145 and 92 patients treated with SBRT for pulmonary metastases.



The median follow up of the trainings cohort was 14.3months, the 2-year and 5-year OS was 52.6% and 23.7%, respectively. Karnofsky performance index, type of the primary tumor, control of the primary tumor, maximum diameter of the largest treated metastasis and number of metastases (1 versus >1) were significant prognostic factors in the Cox model (all p<0.05). The calculated concordance-index for the nomogram was 0.73 (concordance indexes of all prognostic factors between 0.54 and 0.6). Based on the nomogram the training cohort was divided into 4 groups and 2-year OS ranged between 24.2% and 76.1% (predicted OS between 30.2% and 78.4%). The nomogram discriminated between risk groups in the two validation cohorts (concordance index 0.68 and 0.67).



A nomogram for prediction of OS after SBRT for pulmonary metastases was generated and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.



A nomogram for prediction of overall survival after stereotactic body radiotherapy (SBRT) for pulmonary metastases was developed and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
S
S
Tanadini-Lang
Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany.
J
J
Rieber
Department of Oncology, University of Torino, Torino, Italy.
A R
AR
Filippi
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
M M
MM
Fode
Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany.
J
J
Streblow
Department of Radiation Oncology, University Hospital Freiburg, Germany.
S
S
Adebahr
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, University of Rostock, Germany.
N
N
Andratschke
Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany.
O
O
Blanck
Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
J
J
Boda-Heggemann
Department of Radiation Oncology, Technical University Munich, Germany.
M
M
Duma
Department of Radiation Oncology, University Hospital Aachen, Germany.
M J
MJ
Eble
Department of Radiation Oncology, University Hospital Münster, Germany.
I
I
Ernst
Department of Radiation Oncology, University Hospital Wuerzburg, Germany.
M
M
Flentje
Department of Radiation Oncology, 11 Ludwig Maximilians University Munich, Germany.
S
S
Gerum
Department of Radiation Oncology, University Hospital Magdeburg, Germany.
P
P
Hass
Department of Radiotherapy and Special Oncology, Medical School Hannover, Germany.
C
C
Henkenberens
Department of Radiation Oncology, University of Rostock, Germany.
G
G
Hildebrandt
Department of Radiation Oncology, University Hospital Frankfurt, Germany.
D
D
Imhoff
Department of Radiation Oncology, Hospital Augsburg, Germany.
H
H
Kahl
Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland.
N D
ND
Klass
Department of Radiation Oncology, Helios Klinikum Berlin Buch, Germany.
R
R
Krempien
Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg Germany and German Cancer Consortium (DKTK), Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
F
F
Lohaus
Department of Radiation Oncology, University Hospital Hamburg, Germany.
C
C
Petersen
Department of Radiation Oncology, Hospital Heidenheim, Germany.
E
E
Schrade
Department of Radiation Oncology, University Hospital Jena, Germany.
T G
TG
Wendt
Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Germany.
A
A
Wittig
Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
M
M
Høyer
Department of Oncology, University of Torino, Torino, Italy.
U
U
Ricardi
Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany; German Cancer Research Center, Clinical Cooperation Unit Radiation Oncology, Heidelberg, Germany.
F
F
Sterzing
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland. Electronic address: matthias.guckenberger@usz.ch.
M
M
Guckenberger
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D016634:Radiosurgery; D055815:Young Adult
Nomogram; Oligo-metastasis; Overall survival; Stereotactic body radiotherapy