Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada.
Department of Radiology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada.
Curr Oncol. 2023 Oct 24;30(11):9382-9391. doi: 10.3390/curroncol30110679.
Brain metastases (BM) are increasingly being treated using stereotactic radiosurgery (SRS). Standardized response criteria are necessary to improve research and treatment protocols. This study's goal was to validate the RANO-BM criteria thresholds for tumor progression in a cohort of patients with brain metastases managed using SRS.
We performed a retrospective analysis of patients treated at least twice with SRS for brain metastases. Local progression, as defined by RANO-BM criteria, was compared to our multidisciplinary tumor board's treatment recommendation. A ROC curve was generated using varying diameter thresholds to assess the sensitivity and specificity of current RANO-BM criteria.
249 metastases in 67 patients were included in the analysis. RANO-BM criteria current progression thresholds yielded a sensitivity of 38%, a specificity of 95%, a positive predictive value of 71%, and a negative predictive value of 84% relative to our tumor board's treatment recommendation. Modified RANO-BM criteria using absolute diameter differences of 2.5 mm yielded a sensitivity of 83%, a specificity of 87%, a positive predictive value of 67% and a negative predictive value of 94%.
Current RANO-BM criteria unreliably identifies clinically relevant tumor progression. The use of absolute diameter differences thresholds appears superior in our BM cohort.
脑转移瘤（BM）越来越多地采用立体定向放射外科（SRS）进行治疗。为了改进研究和治疗方案，有必要制定标准化的反应标准。本研究的目的是在使用 SRS 治疗脑转移瘤的患者队列中验证 RANO-BM 肿瘤进展标准的阈值。
我们对至少两次接受 SRS 治疗脑转移瘤的患者进行了回顾性分析。根据 RANO-BM 标准定义的局部进展与我们多学科肿瘤委员会的治疗建议进行了比较。使用不同直径阈值生成 ROC 曲线，以评估当前 RANO-BM 标准的敏感性和特异性。
在 67 名患者的 249 个转移灶中进行了分析。与我们肿瘤委员会的治疗建议相比，当前 RANO-BM 标准的进展阈值的敏感性为 38%，特异性为 95%，阳性预测值为 71%，阴性预测值为 84%。使用 2.5 毫米绝对直径差异的修改后的 RANO-BM 标准，敏感性为 83%，特异性为 87%，阳性预测值为 67%，阴性预测值为 94%。
当前的 RANO-BM 标准不能可靠地识别临床相关的肿瘤进展。在我们的 BM 队列中，使用绝对直径差异阈值似乎更优越。
