Article
The impact of postoperative tumour burden on patients with brain metastases
Der Einfluss des postoperativen Tumorvolumens auf Patienten mit Hirnmetastasen
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Published: | May 25, 2022 |
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Objective: Brain metastases were considered to be well-defined lesions, but recent research points to infiltrating behavior. Impact of postoperative residual tumor burden (RTB) and extent of resection are still not defined enough.
Methods: Adult patients with surgery of brain metastases between 04/2007-01/2020 were analyzed. Early postoperative MRI (<72h) was used to segment RTB. Survival analysis were performed and cut-off values for RTB revealed. Separate (subgroup) analyses regarding postoperative radiotherapy, age and histopathological entities were performed.
Results: 704 patients were included. Complete cytoreduction was achieved in 487/704 (69.2%) patients, median preoperative tumor burden was 12.4 cm 3 (IQR 5.2-25.8 cm 3),median RTB 0.14 cm 3 (IQR 0.0-2.05 cm 3) and median postoperative tumor volume of the targeted BM was 0.0 cm 3 (IQR 0.0-0.1 cm 3). Median overall survival was 6 months (IQR 2-18). In multivariate analysis preoperative KPSS (HR 0.981982, 95% CI, 0.9761-0.9873, P <.001), age (HR 1.012363; 95% CI, 1.0043-1.0205, P = .0026), preoperative (HR 1.004906; 95% CI, 1.0003-1.0095, P = .00362) and postoperative tumor burden (HR 1.017983; 95% CI;
1.0058-1.0303, P = .0036) were significant. Maximally selected log rank statistics showed a significant cut-off for RTB of 1.78 cm 3 (P = .0022) at all, 0.28 cm 3 (P = .0047) for targeted metastasis and cut-off for age of 67 years (P < .001). (Stereotactic) Radiotherapy had a significant impact on survival (P < .001).
Conclusion: RTB is a strong predictor for survival. Maximal cytoreduction, as confirmed by postoperative MRI, should be achieved whenever possible, regardless of type of postoperative radiotherapy.