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Peer-Reviewed Publication
Radiother Oncol2025;210111031.September 1, 2025Journal Article

Improving risk assessment of local failure in brain metastases patients using vision transformers - A multicentric development and validation study.

Ayhan Can Erdur1, Daniel Scholz2, Q Mai Nguyen3, Josef A Buchner3, Michael Mayinger4, Sebastian M Christ4, Thomas B Brunner5, Andrea Wittig6, Claus Zimmer7, Bernhard Meyer8, Matthias Guckenberger4, Nicolaus Andratschke4, Rami A El Shafie9, J Urgen Debus10, Susanne Rogers11, Oliver Riesterer11, Katrin Schulze12, Horst J Feldmann12, Oliver Blanck13, Constantinos Zamboglou14, Angelika Bilger-Z15, Anca L Grosu15, Robert Wolff16, Kerstin A Eitz17, Stephanie E Combs17, Denise Bernhardt18, Benedikt Wiestler19, Daniel Rueckert20, Jan C Peeken21
1Department of Radiation Oncology, TUM School of Medicine, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany; Chair for AI in Healthcare and Medicine, Technical University of Munich (TUM) and TUM University Hospital, Munich, Germany. Electronic address: can.erdur@tum.de.
2Chair for AI in Healthcare and Medicine, Technical University of Munich (TUM) and TUM University Hospital, Munich, Germany; AI for Image-Guided Diagnosis and Therapy, TUM School of Medicine and Health, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
3Department of Radiation Oncology, TUM School of Medicine, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
4Department of Radiation Oncology, University of Zurich, Zurich, Switzerland.
5Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany.
6Department of Radiation Oncology, University Hospital W¨urzburg, Julius-Maximilians-University, W¨urzburg, Germany.
7Department of Neuroradiology, TUM School of Medicine, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
8Department of Neurosurgery, TUM School of Medicine, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
9Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany; Department of Radiation Oncology, University Medical Center G¨ottingen, Göttingen, Germany.
10Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany.
11Radiation Oncology Center KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
12Department of Radiation Oncology, General Hospital Fulda, Fulda, Germany.
13Department of Radiation Oncology, University Medical Center Schleswig Holstein, Kiel, Germany; Saphir Radiosurgery Center Frankfurt and Northern Germany, Kiel, Germany.
14Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus.
15Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany.
16Saphir Radiosurgery Center Frankfurt and Northern Germany, Kiel, Germany; Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany.
17Department of Radiation Oncology, TUM School of Medicine, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany; Deutches Konsortium f¨ur Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Helmholtz Center Munich, Munich, Germany.
18Department of Radiation Oncology, TUM School of Medicine, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany; Deutches Konsortium f¨ur Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
19AI for Image-Guided Diagnosis and Therapy, TUM School of Medicine and Health, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
20Chair for AI in Healthcare and Medicine, Technical University of Munich (TUM) and TUM University Hospital, Munich, Germany; Department of Computing, Imperial College London, London, United Kingdom.
21Department of Radiation Oncology, TUM School of Medicine, TUM University Hospital rechts der Isar, Technical University of Munich, Munich, Germany; Deutches Konsortium f¨ur Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Helmholtz Center Munich, Munich, Germany. Electronic address: jan.peeken@tum.de.
PubMed DOI

Abstract

BACKGROUND AND PURPOSE: This study investigates the use of Vision Transformers (ViTs) to predict Freedom from Local Failure (FFLF) in patients with brain metastases using pre-operative MRI scans. The goal is to develop a model that enhances risk stratification and informs personalized treatment strategies. MATERIALS AND METHODS: Within the AURORA retrospective trial, patients (n = 352) who receiv…

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