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Abstract
Objective To develop and validate a nomogram to predict epilepsy in patients with radiation-induced brain necrosis (RN).
Methods The nomogram was based on a retrospective analysis of 302 patients who were diagnosed with symptomatic RN from January 2005 to January 2016 in Sun Yat-sen Memorial Hospital using the Cox proportional hazards model. Discrimination of the nomogram was assessed by the concordance index (C index) and the calibration curve. The results were internally validated using bootstrap resampling and externally validated using 128 patients with RN from 2 additional hospitals.
Results A total of 302 patients with RN with a median follow-up of 3.43 years (interquartile range 2.54–5.45) were included in the training cohort; 65 (21.5%) developed symptomatic epilepsy during follow-up. Seven variables remained significant predictors of epilepsy after multivariable analyses: MRI lesion volume, creatine phosphokinase, the maximum radiation dose to the temporal lobe, RN treatment, history of hypertension and/or diabetes, sex, and total cholesterol level. In the validation cohort, 28 out of 128 (21.9%) patients had epilepsy after RN within a median follow-up of 3.2 years. The nomogram showed comparable discrimination between the training and validation cohort (corrected C index 0.76 [training] vs 0.72 [95% confidence interval 0.62–0.81; validation]).
Conclusion Our study developed an easily applied nomogram for the prediction of RN-related epilepsy in a large RN cohort.
Classification of evidence This study provides Class III evidence that a nomogram predicts post-RN epilepsy.
Glossary
- CK=
- creatine phosphokinase;
- Dmax=
- maximum radiation dose;
- HDL=
- high-density lipoprotein;
- IMRT=
- intensity-modulated radiation therapy;
- IQR=
- interquartile range;
- LDL=
- low-density lipoprotein;
- NPC=
- nasopharyngeal carcinoma;
- RN=
- radiation-induced brain necrosis;
- RPLS=
- reversible posterior leukoencephalopathy syndrome
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
Class of Evidence: NPub.org/coe
- Received November 13, 2019.
- Accepted in final form March 11, 2020.
- © 2020 American Academy of Neurology
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