Article
Risk factors for local in-brain progression after resection of cerebral metastases
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Published: | June 9, 2017 |
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Objective: Surgical treatment of cerebral metastases aims to achieve a long-lasting local control with a low morbidity. However, 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.
Methods: Two hundred thirteen patients operated on in a seven-year period with cerebral metastases of a carcinoma or melanoma, were retrospectively studied. Occurrence of local in-brain-progression was correlated with primary tumor entity, histopathological subtype, radiological features, adjuvant therapy and degree of surgical resection as assessed by an early post-operative MRI < 72h after surgery.
Results: From the two hundred thirteen patients evaluated, 106 were females. Median age was 63 years. Mean preoperative Karnofsky score was 90%. Most common primary tumors were non-small cell lung cancer (43.2%), melanoma (11.7%), gastrointestinal (11.7%), breast cancer (10.3%). From the histopathological point of view, most patients suffered from adenocarcinoma (68.5%), followed by malignant melanoma (11.7%), small-cell carcinoma (7.5%). A total of 51 (23.9%) patients developed a local recurrence. Univariate analysis showed, that detection of residual tumor in early postoperative MRI (<72hr) was the only risk factor for development of a local in-brain progression (2=19.4739>crit=5.991; p<0.05; Chi Square). In contrast, primary tumor, histological type, type of resection, dural involvement, cystic tumor or location were not significant factors for a local in-brain recurrence. Mean local progression free-survival was 9 months (0-74m). Mean follow-up was 12-months.
Conclusion: Our study indicates that detection of residual tumor in an early postoperative MRI < 72h was the only significant risk factor for local in-brain progression of cerebral metastases. Therefore, postoperative MRI < 72h might identify patients at risk for a local in-brain progression and enable a specific therapy of the tumor rest. Further studies are needed in order to evaluate the oncological impact.