Artikel
Risk factors for local in-brain progression after resection of cerebral metastases
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Circumferential stripping of cerebral metastases is the standard surgical treatment, but is often insufficient to achieve local control. Local recurrence occurs in up to 50 - 70% of surgically treated metastases if not combined with an adjuvant radiation therapy. We aimed to identify risk factors of local brain-progression after surgical metastases resection.
Method: A retrospective analysis was performed in 152 patients who underwent surgical resection of a carcinoma (CA) or malignant melanoma metastasis in a four-year period. Occurrence of local in-brain-progression was correlated with the histo-pathological subtype, the primary tumor entity, radiological features and degree of surgical resection as assessed by an early post-operative MRI < 72h after surgery.
Results: The vast majority of patients suffered from adeno-CA (69.1%) followed by small cell CA 10.5%, malignant melanoma 12.5% andothers 7.9%. The most common primary tumors were non-small lung cancer (43.4%), malignant melanoma (12.5%), breast cancer or a gastro-intestinal carcinoma (each 11.8%). In total, 49/152 (32.2%) patients developed a local recurrence. Local recurrence was correlated with detection of residual tumor on early postoperative MRI < 72h (Pearson-χ2 .002), dural infiltration (χ2 .041) and occurrence of distant in-brain progression (χ2 .000). The histo-pathological subtype (χ2 .09), primary tumor (χ2 .056) and gender (χ2 .106) was not significantly correlated with occurrence of local in-brain-progression. Mean local progression-free survival was 9 month (0 - 43m).
Conclusions: Detection of residual tumor on an early postoperative MRI < 72h and dural infiltration may be risk factors for local in-brain progression. The impact of the histo-pathological subtype and primary tumor for local progression has to be evaluated in further studies. A careful preoperative evaluation, identification of risk factors, and a specific therapy might reduce local recurrences.