Features of International Publications in Vietnamese Radiological Societies after The Enactment of 37/2018/QD-TTg.

Background: In Vietnam, after the enactment of 37/2018/QD-TTg, a distinct shift could be observed in the international publications by radiological societies. Objctive: This study examined trends in the international publications achieved by Vietnamese radiological societies following the enactment of 37/2018/QD-TTg. Methods: This retrospective study evaluated data that are freely accessible and available online and, therefore, did not require institutional review board approval. We assessed the publication characteristics of the members of four Vietnamese radiological societies: Vietnamese Society of Radiology and Nuclear Medicine (VSRNM, n = 67); Radiological Society of Ho Chi Minh City (RSHCM, n = 25); Vietnamese Society of Ultrasound in Medicine (VSUM, n = 29); and Vietnamese Society of Interventional Radiology (VSIR, n = 18), following the enactment of 37/2018/QD-TTg. Results: Following the enactment of 37/2018/QD-TTg, we observed that total publications, number of first authors, number of last authors, number of articles indexed in Web of Science, and number of articles indexed in Scopus were significantly higher for the VSRNM and VSIR than for the RSHCM and VSUM. All publication parameters were significantly higher men, individuals who secured professorship, PhD and Master's degree holders, public hospital employees, those in the radiological field, and those in the north and south regions, compared with the values for women, individuals without professorships, Specialist II and I degree holders, private hospital employees, those in the nuclear medicine field, and those in the middle region, respectively. Conclusion: The enactment of 37/2018/QD-TTg triggered a new trend in international publication among the members of four Vietnamese radiological societies. However, strong discrepancies remain in total publications, number of first authors, number of last authors, number of articles indexed in Web of Science, and number of articles indexed in Scopus among the members of the four main Vietnamese radiological societies.

Out-of-pocket payments for complementary medicine following cancer and the effect on financial outcomes in middle-income countries in southeast Asia: a prospective cohort study.

BACKGROUND: Complementary medicine, which refers to therapies that are not part of conventional medicine, comprising both evidence-based and non-evidence-based interventions, is increasingly used following a diagnosis of cancer. We aimed to investigate out-of-pocket spending patterns on complementary medicine and its association with adverse financial outcomes following cancer in middle-income countries in southeast Asia. METHODS: In this prospective cohort study, data on newly diagnosed patients with cancer were derived from the ASEAN Costs in Oncology (ACTION) cohort study, a prospective longitudinal study in 47 centres located in eight countries in southeast Asia. The ACTION study measured household expenditures on complementary medicine in the immediate year after cancer diagnosis. Participants were given cost diaries at baseline to record illness-related payments that were directly incurred and not reimbursed by insurance over the 12-month period after study recruitment. We assessed incidence of financial catastrophe (out-of-pocket cancer-related costs ≥30% of annual household income), medical impoverishment (reduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs), and economic hardship (inability to make necessary household payments) at 1 year. FINDINGS: Between March, 2012, and September, 2013, 9513 participants were recruited into the ACTION cohort study, of whom 4754 (50·0%) participants were included in this analysis. Out-of-pocket expenditures on complementary medicine were reported by 1233 households. These payments constituted 8·6% of the annual total out-of-pocket health costs in lower-middle-income countries and 42·9% in upper-middle-income countries. Expenditures on complementary medicine significantly increased risks of financial catastrophe (adjusted odds ratio 1·52 [95% CI 1·23-1·88]) and medical impoverishment (1·75 [1·36-2·24]) at 12 months in upper-middle-income countries only. However, the risks were significantly higher for economically disadvantaged households, irrespective of country income group. INTERPRETATION: Integration of evidence-supported complementary therapies into mainstream cancer care, along with interventions to address use of non-evidence-based complementary medicine, might help alleviate any associated adverse financial impacts. FUNDING: None.

Impacts of Novel Vietnamese Government Regulations on Radiological PhD and Professorship Candidates: an Initial Report.

INTRODUCTION: In Vietnam, the successful publication of research in indexed journals is mandatory to obtain academic appointments and promotions in medical colleges and institutions, according to the current guidelines established by the State Council for Professorship and Ministry of Education and Training. AIM: This study aimed to investigate the impacts of novel Vietnamese government regulations on radiological PhD and professorship candidates. METHODS: This study evaluated freely accessible data, available online, and, therefore, did not require institutional review board approval. We assessed the numbers of radiological PhD candidates at Hanoi Medical University and the numbers of published Vietnamese radiological papers, from 2012 to 2019, indexed in the SCImago database. In addition, we evaluated the numbers of qualified radiological professors and associate professors employed at universities during the same period. We did not include nuclear medicine PhD and professorship candidates, in this study. The data are presented as bar and line charts. RESULTS: Following the enactment of 08/2017/TT-BGDDT and 37/2018/QD-TTg, we observed that the numbers of radiological PhD and professorship candidates were significantly reduced. From 2012 to 2019, only one candidate qualified for appointment as a radiological professor. However, the number of radiological papers rose dramatically during the same time period. CONCLUSION: The enactment of 08/2017/TT-BGDDT and 37/2018/QD-TTg had strong impacts on the numbers of PhD and professorship candidates. Owing to these new regulations, the number of published, international, peer-reviewed radiological papers has increased; however, some undesired consequences may have occurred, such as papers being published in predatory or suspected predatory journals, double or triple submissions, and plagiarism.

Evaluation of Five Survival Scores in a Cohort of Elderly Patients With Cerebral Metastasis from Non-small Cell Lung Cancer.

BACKGROUND/AIM: Survival scores are important for treatment personalisation. A score for older patients with cerebral metastasis from non-small cell lung cancer (NSCLC) was generated. PATIENTS AND METHODS: Dose-fractionation of whole-brain irradiation, age, gender, general condition, histology, count of cerebral lesions, extra-cerebral metastatic spread and time between NSCLC-diagnosis and whole-brain irradiation were analysed for survival in 285 patients. Independent prognostic characteristics were utilised for the score, which was compared against five others. RESULTS: Based on general condition (p<0.001) and extra-cerebral spread (p=0.003), three groups were generated according to the score, 2 (n=49), 4-6 (n=206) and 7 (n=30) points. Positive predictive values (PPVs) to predict death ≤6 months and survival for ≥6 months were 100% and 52%, respectively. PPVs of other scores were 88-98% and 60-63%. CONCLUSION: The accuracy of the new score to predict death within ≤6 months was optimal, whereas its accuracy to predict survival for ≥6 months was lower when compared to the other low PPVs of existing scores.

Remaining Lifespan of Patients Aged ≥65 Years Receiving Whole-brain Irradiation for Metastases from Cancer of Unknown Primary.

BACKGROUND/AIM: Personalized therapies may improve outcomes in elderly patients with brain metastases from cancer of unknown primary (CUP). To contribute to this strategy, an instrument for judging their survival time was designed. PATIENTS AND METHODS: This retrospective study included 53 patients, aged ≥65 years and treated with whole-brain irradiation (WBI) for brain metastases from CUP. The WBI-program, age, gender, Karnofsky performance score (KPS), number of brain metastases and non-cerebral metastases were analyzed. RESULTS: KPS≤60 (p<0.001) and presence of non-cerebral metastases (p=0.003) were significantly associated with unfavorable survival. These factors formed the basis for the prognostic implement; patient-scores of zero (n=23), one (n=21) or two points (n=9) were obtained. Corresponding survival rates at 6-months were 0%, 19% and 56% (p<0.001). CONCLUSION: With this instrument, it is easier to judge the remaining survival time of elderly patients with brain metastases from CUP. This information should be used when selecting individual treatment- and WBI-programs.

Individualisation of Radiation Therapy for Older Persons With Secondary Brain Lesions from Carcinoma of the Breast.

BACKGROUND/AIM: Outcomes of older persons with secondary brain lesions from carcinoma of the breast may be improved by individualized therapy. This process will likely be easier with survival scores. PATIENTS AND METHODS: A retrospective study was performed in 111 older patients with carcinoma of the breast irradiated for secondary brain lesions. Dose-fractionation, age, general condition, number of brain lesions, other visceral metastases and time period from breast cancer detection until radiation therapy were investigated. RESULTS: Post-radiation survival was significantly related to general condition (p<0.0001) and other visceral metastases (p=0.041). When using these characteristics, sum-scores of 0 (n=46), 1 (n=50) or 2 (n=15) points were gained. Six- and 12-month survival was 7% and 3% for 0 points, 43% and 19% for 1 point, and 73% and 52% for 2 points (p<0.0001). CONCLUSION: This survival score contributes to treatment individualisation of older patients with secondary brain lesions from carcinoma of the breast.

Predicting Survival After Whole-brain Irradiation for Cerebral Metastases in Patients with Cancer of the Bladder.

BACKGROUND/AIM: This study aimed to create a predictive tool for estimating the remaining lifespan of patients after whole-brain irradiation (WBI) for cerebral metastases from bladder cancer. PATIENTS AND METHODS: In 34 of these patients clinical parameters were analyzed for survival including age at start of WBI, gender, Karnofsky score, number of cerebral metastases and involvement of extra-cranial sites of metastasis. RESULTS: Involvement of extra-cranial sites (14%) and Karnofsky score (9%) showed the greatest difference regarding 6-month survival and were considered for the tool. Points were assigned based on the following: no involvement of extra-cranial sites=1 point, involvement of extra-cranial sites=0 points, Karnofsky score ≥70=1 point, Karnofsky score ≤60=0 points. Patients' scores were 0, 1 or 2 points with 6-month survival rates of 13%, 27% and 50%, respectively. CONCLUSION: Based on two clinical parameters, a tool was developed that may help estimate the lifespan of patients irradiated for cerebral metastases from bladder cancer.

Predictive Factors for Local Control and Survival in Patients with Cancer of Unknown Primary (CUP) Irradiated for Cerebral Metastases.

BACKGROUND/AIM: To identify predictors of local control and survival after whole-brain irradiation (WBI) for cerebral metastases from cancer of unknown primary (CUP). PATIENTS AND METHODS: In 140 patients receiving WBI alone or following resection, seven factors were investigated including treatment approach, WBI-regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extra-cerebral metastases. RESULTS: On univariate analysis, resection plus WBI and boost (p=0.002), ECOG 0-1 (p<0.001) and a single lesion (p<0.001) were positively associated with local control. On Cox regression, ECOG-score remained significant (p=0.002). On univariate analysis of survival, surgery plus WBI and boost (p=0.009), ECOG 0-1 (p<0.001), a single lesion (p=0.024) and no extra-cerebral metastases (p<0.001) were associated with better outcomes. On Cox regression, ECOG-score (p<0.001) and extra-cerebral lesions (p<0.001) were significant. CONCLUSION: Significant predictors of local control and survival were identified that contribute to treatment personalization and design of prospective trials in patients with cerebral metastases from CUP.

Validation of a Survival Score for Patients Receiving Radiosurgery or Fractionated Stereotactic Radiotherapy for 1 to 3 Brain Metastases.

BACKGROUND/AIM: We developed a scoring system to predict 1-year survival after radiosurgery for 1-3 brain metastases. This study aimed to validate this system. PATIENTS AND METHODS: Seventy-six new patients were included in this validation study. Like in the original scoring-system, three factors (age, performance status, extra-cranial metastases) were used. For each factor, 1-year survival rates in % were divided by 10, and the three scoring-points were added for each patient. RESULTS: Patient's scores were 10, 11, 13, 14, 16 or 17 points with 1-year survival rates ranging between 31% and 80%. Two groups, 10-14 and 16-17 points were formed. In the 14-16 points group, 1-year survival was 47% (versus 33% in the preceding study, p=0.060). In the 16-17 points group, 1-year survival rates were 75% versus 77% (p=0.79). CONCLUSION: In the more favorable group, the scoring-system was very reproducible. In the less favorable group, the difference was larger, but also not signficant.

Rotating Gamma System Irradiation: A Promising Treatment for Low-grade Brainstem Gliomas.

AIM: To evaluate the role of rotating gamma system (RGS) radiosurgery for low-grade brainstem gliomas. PATIENTS AND METHODS: Thirty-seven patients undergoing RGS radiosurgery at the Bach Mai Hospital Hanoi for low-grade brainstem glioma were included in this prospective interventional study. The median RGS dose was 12 Gy (range=8-16 Gy). Endpoints included response to RGS radiosurgery given as change in glioma size (maximum diameter), survival and adverse events. Follow-up was performed for 36 months. Three dose-groups (<13, 13-14 and >14 Gy) were compared for survival. RESULTS: Mean glioma size decreased from 1.87 cm before RGS irradiation to 1.15 cm at 36 months. Mean survival was 39.5 months. Mean survival after <13, 13-14 and >14 Gy were 22.7, 66.7 and 49 months, respectively (p<0.05). Adverse events, mainly reduced appetite, sleep disturbances, headache and edema, were not associated with RGS dose and were easily managed. CONCLUSION: RGS radiosurgery led to promising results with acceptable toxicity in patients with low-grade brainstem gliomas.

Radiosurgery with a Rotating Gamma System: A Very Effective Treatment for Symptomatic Cerebral Cavernomas.

AIM: To evaluate the value of radiosurgery with a rotating gamma-system (RGS) for cerebral cavernomas. PATIENTS AND METHODS: Seventy-nine patients with symptomatic cerebral cavernomas underwent RGS radiosurgery at the Bach Mai Hospital, Hanoi, Vietnam. Median dose (single fraction) was 20 Gy (range=14-26 Gy). Endpoints included effect on headache, seizures and tumor size. RESULTS: Of 60 patients with headache, 17% had complete response, 82% partial response and 2% stable disease (best response). Of 39 patients with seizures, 31% had complete response, 64% partial response and 5% stable disease. Four patients developed recurrent seizures after 1 year. Regarding the size of cavernoma at 15 months, complete response was observed in 6%, partial response in 75%, stable disease in 15%, progression in 1% and pseudo-progression in 3% of patients. Bleeding within 2 years after RGS radiosurgery occurred in only five patients (6%). RGS dose had no significant impact on outcomes. CONCLUSION: RGS radiosurgery provided very high rates of symptom relief in patients with cerebral cavernomas.

A Survival Score Based on Symptoms and Performance Status for Patients with High-grade Gliomas Receiving Radiochemotherapy.

AIM: To create a simple survival score for patients with high-grade gliomas based on clinical symptoms and performance status. PATIENTS AND METHODS: Thirty-six patients received neurosurgical intervention followed by radiochemotherapy for high-grade gliomas. Six pre-treatment symptoms were included in the score depending on their impairment of quality of life, scoring each between 1 and 3. For each patient, the points from the symptoms were added and another 4 points were added for Karnofsky performance status (KPS) <80%. Based on the survival rates of these scores, two groups were formed: 1-4 (group A) and 5-12 points (group B). RESULTS: The 1-, 2- and 3-year survival rates in group A were 100%, 33% and 24% in group A and 47%, 7% and 0% in group B (p<0.001). In addition, complete tumor resection (p<0.001) and tumor grade III (p<0.001) were associated with improved survival. CONCLUSION: A simple survival score was developed helping physicians in decision-making for patients with high-grade gliomas.

A matched-pair analysis comparing whole-brain radiotherapy with and without a stereotactic boost for intracerebral control and overall survival in patients with one to three cerebral metastases.

BACKGROUND: Twelve years ago, a randomized trial demonstrated that a radiosurgery boost added to whole-brain radiotherapy (WBRT) improved intracerebral control (IC) in patients with one to three cerebral metastases. Overall survival (OS) was improved only in the subgroup of patients with a single metastasis but not in the entire cohort. The present study compared both regimens in a different scenario outside a randomized trial. METHODS: A total of 252 patients with one to three cerebral metastases were included. Eighty-four patients receiving WBRT plus a planned stereotactic boost and 168 patients receiving WBRT alone were individually matched 1:2 for nine factors including fractionation of WBRT, age, gender, performance score, primary tumor, number of cerebral metastases, extracerebral metastases, recursive partitioning analysis class, and time between cancer diagnosis and WBRT. Each group of three patients was required to match for all nine factors. Both groups were compared for IC and OS. RESULTS: IC rates at 6, 12, 18 and 24 months were 88, 71, 45 and 22% after WBRT plus stereotactic boost vs. 75, 48, 38 and 22% after WBRT alone (p = 0.005). OS rates at 6, 12, 18 and 24 months were 76, 53, 32 and 25% after WBRT plus stereotactic boost and 67, 45, 29 and 20% after WBRT alone (p = 0.10). In patients with a single lesion, OS rates were also not significantly different (p = 0.12). CONCLUSIONS: Similar to the previous randomized trial from 2004, this matched-pair study showed that a stereotactic boost in addition to WBRT significantly improved IC but not OS.

Local Therapies Can Improve Intracerebral Control in Patients with Cerebral Metastasis from Gynecological Cancers.

BACKGROUND/AIM: Patients with gynecological malignancies account for 2% of patients with cerebral metastases. Many patients receive whole-brain irradiation (WBI) alone. Local therapies (resection, stereotactic radiosurgery (SRS)) are becoming more popular. This study compared intracerebral control after local therapy to WBI alone in patients with gynecological malignancies. PATIENTS AND METHODS: Of 56 patients, 45 received WBI alone, 6 SRS alone and 5 resection plus WBI. Treatment type, age, performance score, cancer site, number of cerebral lesions, metastases outside the brain, recursive partitioning analysis (RPA) class and period from gynecological cancer diagnosis to brain metastasis treatment were evaluated. RESULTS: On univariate analyses, local therapy (p=0.003), single cerebral lesion (p<0.001) and RPA class 1/2 (p=0.027) were positively related to intracerebral control. On Cox regression analysis, local therapy (p=0.013) and RPA class 1/2 (p=0.014) were significant. CONCLUSION: Local therapies led to better intracerebral control than WBI alone and should be considered for brain metastasis from gynecological malignancies whenever reasonable.

Number of cerebral lesions predicts freedom from new brain metastases after radiosurgery alone in lung cancer patients.

Numerous patients with few brain metastases receive radiosurgery, either alone or in combination with whole-brain irradiation. The addition of whole-brain irradiation to radiosurgery reduces the rate of intracerebral failures, particularly the development of new cerebral lesions distant from those treated with radiosurgery. Less intracerebral failures mean less neurocognitive deficits. However, whole-brain irradiation itself may lead to a decline in neurocognitive functions. Therefore, a number of physicians have reservations with regard to adding whole-brain irradiation to radiosurgery. Prognostic factors that allow an estimation of the risk of developing new cerebral metastases can facilitate the decision regarding additional whole-brain irradiation. Since primary tumors show a different biology and clinical course, prognostic factors should be identified separately for each primary tumor leading to brain metastasis. The present study investigated 10 characteristics in a series of 98 patients receiving radiosurgery alone for 1-2 cerebral metastases from lung cancer, the most common primary tumor associated with brain metastasis. These characteristics included radiosurgery dose, age, gender, performance status, histology, number of cerebral lesions, maximum total diameter of cerebral lesions, main location of cerebral lesions, extracranial spread and interval from first diagnosis of lung cancer to administration of radiosurgery. On univariate analysis, the number of cerebral lesions prior to radiosurgery (1 vs. 2 lesions) was the only characteristic significantly associated with freedom from new brain metastases (P=0.002). In cases of 2 lesions, 73% of patients developed new cerebral lesions within 1 year. On multivariate analysis, the number of brain metastases remained significant (risk ratio, 2.46; 95% confidence interval, 1.34-4.58; P=0.004). Given the high rates of new cerebral lesions in patients with 2 brain metastases, these patients should be strongly considered for additional whole-brain irradiation.

Predicting the Risk of New Cerebral Lesions After Stereotactic Radiosurgery (SRS) for Brain Metastases from Breast Cancer.

AIM: To generate a tool that estimates the probability of developing new cerebral metastases after stereotactic radiosurgery (SRS) in breast cancer patients. PATIENTS AND METHODS: SRS dose plus seven characteristics (age, performance score, number of cerebral metastases, maximum diameter of all metastases, location of metastases, extra-cerebral spread and time from breast cancer diagnosis until SRS) were analyzed regarding their ability to predict the probability of new cerebral metastases development following SRS. For those characteristics deemed significant, points of 0 (higher risk of new lesions) or 1 (lower risk) were given. Scores were generated by adding the points of significant characteristics. RESULTS: Performance score (p=0.013) and maximum diameter of all metastases (p=0.022) were associated with development of subsequent brain metastases. Two groups were created, 0-1 and 2 points. Freedom from new cerebral metastases rates were 27% and 92%, respectively, at 15 months (p=0.003). CONCLUSION: This tool helps select breast cancer with few cerebral metastases receiving SRS who may benefit from additional whole-brain irradiation.

Predicting Survival After Irradiation for Brain Metastases from Head and Neck Cancer.

AIM: Patients with cerebral metastases from head and neck cancer are not common. This study aimed to create an instrument for estimating survival in this particular group of patients. PATIENTS AND METHODS: Survival was significantly influenced by Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extracranial metastatic disease. These characteristics were included in our score. RESULTS: Scoring was based on 6-month survival data: ECOG 0-1=1 point, ECOG 2-3=0 points, 1-3 cerebral lesions=1 point, ≥4 cerebral lesions=0 points, lack of extracranial metastases=1 point, and presence of extracranial metastases=0 points. Addition of these points for each patient resulted in 0-3 points. Three groups were built comprising 0-1, 2 and 3 points. Six-month survival rates for these groups were 0%, 50% and 100%, respectively. CONCLUSION: This new instrument guides physicians in choosing optimal irradiation programs for patients with cerebral metastases from head-and-neck cancer.

A New Predictive Tool for Optimization of the Treatment of Brain Metastases from Colorectal Cancer After Stereotactic Radiosurgery.

AIM: To develop a predictive tool for survival after stereotactic radiosurgery of brain metastases from colorectal cancer. PATIENTS AND METHODS: Out of nine factors analyzed for survival, those showing significance (p<0.05) or a trend (p≤0.06) were included. For each factor, 0 (worse survival) or 1 (better survival) point was assigned. Total scores represented the sum of the factor scores. RESULTS: Performance status (p=0.010) and interval from diagnosis of colorectal cancer until radiosurgery (p=0.026) achieved significance, extracranial metastases showed a trend (p=0.06). These factors were included in the tool. Total scores were 0-3 points. Six-month survival rates were 17% for patients with 0, 25% for those with 1, 67% for those with 2 and 100% for those with 3 points; 12-month rates were 0%, 0%, 33% and 67%, respectively. Two groups were created: 0-1 and 2-3 points. Six- and 12-month survival rates were 20% vs. 78% and 0% vs. 44% (p=0.002), respectively. CONCLUSION: This tool helps optimize the treatment of patients after stereotactic radiosurgery for brain metastases from colorectal cancer.

Defining the Optimal Dose of Stereotactic Radiosurgery for Treating Cerebral Metastases in Elderly Patients.

BACKGROUND/AIM: In oncology, elderly people are a separate group of patients requiring special consideration. This applies to the treatment of cerebral metastases as well. The present study focused on elderly patients receiving stereotactic radiosurgery (SRS) for few cerebral lesions. PATIENTS AND METHODS: In 95 patients aged ≥65 years, two SRS doses, 16-18 Gy (n=44) and 20 Gy (n=51), were compared regarding outcomes of SRS. RESULTS: The overall intracerebral control rates at 12 months were 30% after 16-18 Gy and 45% after 20 Gy (p=0.53). Twelve-month rates of freedom from new intracerebral lesions were 41% and 52%, respectively (p=0.63). Twelve-month local control rates of the irradiated lesions were 55% and 81%, respectively (p=0.069). Overall survival rates at 12 months were 29% and 31%, respectively (p=0.67). CONCLUSION: SRS with 16-18 Gy was not significantly inferior to SRS with 20 Gy in elderly patients with few cerebral metastases.

Estimation of the Six-month Survival Probability After Radiosurgery for Brain Metastases from Kidney Cancer.

AIM: To generate an overall survival score for patients with kidney cancer who underwent radiosurgery for brain metastases. PATIENTS AND METHODS: Thirty-six patients who received radiosurgery alone for 1-3 brain metastases from kidney cancer were included. On multivariate analysis of a preceding study of such patients, Karnofsky performance score (KPS) and extracranial spread were significantly associated with overall survival and formed the basis for this score. For each patient, the prognostic score was derived from adding the points of KPS and extracranial spread resulting in a score of 9, 12, 15 or 18 points. RESULTS: Six-month overall survival rates were 13% for patients with 9 points, 80% for those with 12 points, 79% for those with 15 points and 100% for those with 18 points, respectively. Three groups of patients were defined with scores of 9, 12-15 and 18 points. Six-month overall survival rates were 13%, 79% and 100%, respectively (p=0.004). CONCLUSION: This new score facilitates personalized treatment decisions for patients with kidney cancer with very few brain metastases.