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Abstract
Gamma Knife surgery (GKS) for brain metastasis (BM) has been generally advocated for patients with a Karnofsky performance status (KPS) scale of ≥ 70. However, some patients with a poor KPS scale of < 70 are recoverable after GKS and show durable survival. A purpose of this study is to devise a 3-month survival prediction model to screen patients with BM with a KPS of ≤ 70 in whom GKS is needed. A retrospective analysis of 67 patients with a KPS scale of 60-70 undergoing GKS for BM of non-small cell lung cancer (NSCLC) from 2016 to 2020 in our institute was performed. Univariate and multivariate logistic regression analyses were performed to investigate factors related to survival for more than 3 months after GKS. The probability (P) prediction model was designed by giving a weight corresponding to the odds ratio of the variables. The overall survival was 9.9 ± 12.7 months (range 0.2-53.2), with a 3-month survival rate of 59.7% (n = 40). In multivariate logistic regression analysis, extracranial disease (ECD) control (p = .033), focal neurological deficit (FND) (p = .014), and cumulative tumor volume (∑ TV) (p = .005) were associated with 3-month survival. The prediction model of 3-month survival (Harrell's C index = 0.767) was devised based on associated factors. In conclusion, GKS for BMs is recommended in selected patients, even if the KPS scale is ≤ 70.

Affiliations

Hangeul Park 1, Hyun-Tai Chung 1 2 3, Jin-Wook Kim 1 2 3, Yun-Sik Dho 4, Eun Jung Lee 5 6 7
1Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
2Gamma Knife Radiosurgery Center, Seoul National University Hospital, Seoul, Republic of Korea.
3Seoul National University College of Medicine, Seoul, Republic of Korea.
4Neuro-Oncology Clinic, National Cancer Center, Goyang, Republic of Korea.
5Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. eunjlee21@snu.ac.kr.
6Gamma Knife Radiosurgery Center, Seoul National University Hospital, Seoul, Republic of Korea. eunjlee21@snu.ac.kr.
7Seoul National University College of Medicine, Seoul, Republic of Korea. eunjlee21@snu.ac.kr.