gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Artikel

Artikel empfehlen

Brain metastases in the elderly – impact of residual tumour volume on overall survival

Hirnmetastasen bei älteren Patienten – Einfluss des Resttumorvolumens auf das Gesamtüberleben

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Lea Baumgart - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Amir Kaywan Aftahy - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Melanie Barz - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Aida Anetsberger - Klinikum rechts der Isar der TU München, Anästhesiologie und Intensivmedizin, München, Deutschland; Hochschule Landshut, Universität für angewandte Wissenschaften, Interdisziplinäre Studien, Landshut, Deutschland
  • Dennis Thunstedt - Klinikum der Ludwig-Maximilians-Universität München, Neurologie, München, Deutschland
  • Benedikt Wiestler - Klinikum rechts der Isar der TU München, Neuroradiologie, München, Deutschland
  • Denise Bernhardt - Klinikum rechts der Isar der TU München, Radioonkologie, München, Deutschland; Deutsches Konsortium für Translationale Krebsforschung (DKTK), München, Deutschland
  • Stephanie E. Combs - Klinikum rechts der Isar der TU München, Radioonkologie, München, Deutschland; Deutsches Konsortium für Translationale Krebsforschung (DKTK), München, Deutschland; Institut für Strahlenmedizin (IRM), Helmholtz Zentrum, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Jens Gempt - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV167

doi: 10.3205/22dgnc163, urn:nbn:de:0183-22dgnc1630

Veröffentlicht: 25. Mai 2022

© 2022 Baumgart et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Due to demographic changes and an increased incidence of cancer with age, the number of patients with brain metastases (BM) is constantly increasing, especially among the elderly. Nevertheless, geriatric patients are often overlooked in clinical trials and impact of resection of BM is a frequently debated topic, that remains unclear and needs to be addressed. The aim of this study was to analyze the impact of resection and residual tumor volume of elderly patients with BM to determine significant markers on postoperative clinical outcome and overall survival (OS).

Methods: Patients ≥ 75 years and surgery for BM between 04/2007 – 01/2020 were retrospectively included. The respective cohort is the elderly subgroup of a larger cohort that was analyzed and submitted as an abstract as well. Due to the special question regarding age, a separate investigation was carried out here. Residual tumor burden (RTB) was segmented using early postoperative MRI (72h). Impact of preoperative KPSS, age, sex and RTB on OS was analyzed. Survival analyses were performed using Kaplan-Meier estimates for univariate analysis and Cox regression proportional hazards model for multivariate analysis.

Results: 101 patients were included, median age was 78 years. 62 patients (61%) had a single BM, 16 patients (16%) had 2 BM, 13 patients (13%) had 3 BM and 10 patients (10%) had ≥3 BM. Median preoperative tumor burden was 10.3 cm3 (IQR 5-25 cm3) and postoperative tumor burden 0 cm3 (IQR 0-1.1 cm3). Complete cytoreduction (RTB=0) was achieved in 52 patients (52%), complete resection of the targeted BM in 78 patients (78%). Median OS was 7 months (IQR 2-11). In univariate analysis preoperative KPSS (HR 0.986, 95% CI 0.973-0.998, p=.026) and postoperative tumor burden (HR 1.025, 95%CI 1.002-1.047, p=.029) were significant parameters for OS. Hereby, RTB=0 was significantly associated with prolonged median OS compared to RTB>0 (12 months vs. 5 months, p=.007). Furthermore, prolongation of OS was significantly associated with surgery in patients with a favorable KPSS, with an adjusted HR of 0.986 (p=.026). However, there were no significances regarding age.

Conclusion: RTB is a strong predictor for OS, regardless of age or cancer type. Extent of resection should be confirmed by postoperative MRI as complete resection is not warranted by intraoperative estimates. It is crucial to aim for maximal cytoreduction to achieve the best long-term outcome for these patients, despite the fact they are advanced in age.