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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Risk factors for local in-brain progression after resection of cerebral metastases

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  • Marcel A. Kamp - Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
  • Julia Bühner - Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
  • Marion Rapp - Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
  • Hans-Jakob Steiger - Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
  • Philipp J. Slotty - Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
  • Michael Sabel - Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.17.06

doi: 10.3205/16dgnc340, urn:nbn:de:0183-16dgnc3406

Published: June 8, 2016

© 2016 Kamp et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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.