Artikel
Surgery for single brain metastases – a complete resection proven by early postoperative MR imaging prolongs patinet survival
Operation einzelner Hirnmetastasen – eine im frühpostoperativen MRT bestätigte Komplettresektion verlängert das Patientenüberleben
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Autoren
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Neda Mokhtari
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Tunc Faik Ersoy
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Alexander Grote
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Matthias Simon
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: To evaluate the potential impact of the degree of resection on survival after surgery for single brain metastases. Brain metastases are believed to be circumscribed, well-delineated tumors and therefore easy to resect completely.Nevertheless, postoperative MR imaging reveals residual tumor in a substantial number of cases.
Methods: We retrospectively identified all 257 cases undergoing surgery between March 2016 and March 2020 for the removal of brain metastases in our departmental electronic database. 85 cases were operated for a single metastasis and had early postoperative MR imaging. We recorded all pertinent clinical data. Follow-up information was obtained through our outpatient department. All postoperative MR studies were reviewed and assessed for residual tumor (RANO 2015 criteria): complete resection vs. nonmeasurable (contrast enhancing lesion < 10 mm in one dimension) vs. measurable tumour. Standard statistical analyses including Kaplan Meier estimates, logistic and Cox regression analysis using a commercially available software (SSPS 25, IBM) were performed.
Results: The series comprised 47 (55.3%) females and 38 (44.7%) males. Median age was 60.9 (25-75% IQR: 54.3-70.1) years. 22 (25.9%) tumors were located in the posterior fossa. The most frequent primary tumor locations were lung (44.7%), breast (18.8%) and the GI tract (16.5%). The median preoperative KPI was 90 (25-75% IQR: 80-90) and the median postoperative KPI was also 90 (25-75% IQR: 80-90). 95% of cases had postoperative radio- and/or chemotherapy. Median postoperative survival was 22.5 months. Residual tumor was predictive of survival: complete resection (N=63) vs. non-measurable (N=13) vs. measurable residual disease (N=9) - median overall survival not reached vs. 15.1. vs. 13.8 months; p=0.021). Extracerebral metastases had a borderline negative prognostic impact (p=0.051). Infratentorial location, age and preoperative KPI did not correlate significantly with survival.
Conclusion: Our data point to a very significant correlation between degree of resection and survival after surgery for single brain metastases. This supports routine early postoperative MR imaging after brain metastases removal and also points to a potential role of repeat surgery for residual metastatic disease if safely possible.
