Local control and dose selection for lung cancer brain metastases treated with radiosurgery: an artificial...

Clinical and radiological outcomes after Stereotactic radiosurgery (SRS) for lung cancer brain metastases are heterogeneous, and prescription dose selection is often guided by experience rather than individual patient and tumor specific features. A data-driven approach that links dose to quantitative local control and adverse effect predictions could improve planning and follow-up strategies. We performed a retrospective single-center cohort study of lung cancer brain metastases treated with GKRS at the University of Pittsburgh Medical Center (2014-2024). Using routinely available clinical, tumor, and dosimetric variables, we trained a tumor-level Random Survival Forest to predict Local Control and Dose Selection for Lung Cancer Brain Metastases after GKRS treatment. Internal validation used leakage-resistant patient-level grouped cross-validation. Performance was assessed using Harrell's concordance index (C-index) and integrated Brier score (IBS). A connected dose-sweep decision layer evaluated predicted local control across a clinically feasible margin dose grid and selected the dose associated with the most favorable predicted profile at prespecified horizons. The survival model demonstrated good internal performance (C-index 0.83; IBS 0.15). A baseline dose imitation model predicted historical margin dose with low error (OOF MAE 1.59 Gy). The integrated decision layer generated individualized local control trajectories and returned horizon-specific local control probabilities and model-based prescription dose recommendations. An Artificial Intelligence framework integrating time-to-event prediction with outcome-linked dose sweeping can provide individualized GKRS decision support for lung cancer brain metastases by delivering quantitative local control forecasts and model-based dose recommendations.