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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Long-term survival in patients with brain metastases: a retrospective analysis

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  • Tareq A. Juratli - Klinik und Polklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • Silke Soucek - Klinik und Polklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • Matthias Kirsch - Klinik und Polklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • Gabriele Schackert - Klinik und Polklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.06.07

doi: 10.3205/13dgnc212, urn:nbn:de:0183-13dgnc2129

Published: May 21, 2013

© 2013 Juratli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The purpose of our retrospective study is to assess long-term survival in patients with brain metastases (BM) and to identify predictors of improved overall survival (OS).

Method: A mono-center analysis of long-term survival (defined as survival >24 months) including all cancer patients with brain metastases treated surgically at our institution between 2000 and 2012, was performed. Prognostic factors for survival were examined by uni- and multivariate analyses.

Results: In total, 53 of 507 patients (10.5%, 40% female and 60% male) were defined to be long-term survivors. 36 (86%) had an OS > 36 months. The mean OS of all patients was 54 months. Primary tumors were: 14 bronchial carcinomas, 10 urothelial carcinomas, 9 breast carcinomas, 8 gastrointestinal carcinomas, 7 malignant melanomas and 6 others. Patients with breast cancer had the longest OS (median 66 months), whereas patients with gastrointestinal cancer had the shortest OS (median 35.6 months). 33 patients (62%) suffered from systemic metastases (SM) with the highest frequency related to bronchial carcinoma. BM occurred in long-term survivors most commonly in the frontal lobe, followed by the parietal lobe. The left brain hemisphere was shown to be more affected by BM than the right hemisphere. The patients' median OS with SM was non-inferior compared to those without SM (64 vs. 60 months). In patients with SM, the median time of relapse was significantly shorter than in those without SM (35.5 vs. 60.5m). 43 patients had a single BM (mOS 54 months), 10 had multiple BM (mOS 48 months), (p>0.05). 33 patients (62%) underwent one surgical resection, 11 (20%) had two and 9 (18%) had three surgeries or more. 23 patients (43%) had no radiation therapy (RT), 20 (37.7%) had a one-time RT, the rest received at least 2 RT. In most cases, RT was performed as whole brain RT, followed by salvage RT. Only 4 patients (7.5%) received chemotherapy. The multivariate analysis revealed two independent prognostic factors for long-term survival: primary tumor histology and BM location (frontal lobe).

Conclusions: Despite the dismal prognosis of patients with BM, 10.5% of our patients in this series were long-term survivors. Favorable factors were histology of the primary tumor, BM location and consequent treatment.