gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Do size or multiplicity of cerebral metastases predict Infiltration into brain parenchyma?

Meeting Abstract

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  • Ingo Fiss - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Christina Wolfert - Abteilung für Neurochirurgie, Göttingen, Deutschland
  • Silvia Hernandez Duran - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Annalen Bleckmann - Universitätsmedizin Göttingen, Klinik für Hämatologie und Medizinische Onkologie, Göttingen, Deutschland
  • Tobias Pukrop - Universitätsmedizin Göttingen, Klinik für Hämatologie und Medizinische Onkologie, Göttingen, Deutschland
  • Christine Stadelmann - Universitätsmedizin Göttingen, Institut für Neuropathologie, Göttingen, Deutschland
  • Swetlana Sperling - Göttingen, Deutschland
  • Alonso Barrantes-Freer - Göttingen, Deutschland
  • Bawarjan Schatlo - Universitätsmedizin Göttingen, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.23.03

doi: 10.3205/17dgnc138, urn:nbn:de:0183-17dgnc1385

Published: June 9, 2017

© 2017 Fiss 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

Text

Objective: Cerebral metastases are known to exhibit infiltrative behavior beyond macroscopic tumor boundaries. We hypothesized that the size of a cerebral metastasis and the presence of multiple filiae are predictors of cellular invasion beyond the conventional limits of a tumor as determined by macroscopic appearance. This could have implications on the surgical treatment of larger metastases which might warrant more aggressive – i.e. supratotal – resection strategies.

Methods: Patients with suspected cerebral metastases were enrolled in a prospective protocol and underwent resection of a cerebral lesion. Based on the Metastasys-trial protocol, biopsies were obtained at the margins of resection and analyzed for histological evidence of tumor cells. The size and number of cerebral lesions were correlated with the dichotomized invasion pattern using Chi2-tests with a 2-sided significance level of p<0.05. Statistical workup was performed using SPSS 18.0 (IBM).

Results: Sixty-one patients were operated with a mean age of 63+-8 years. 26/61 patients (43%) had evidence of more than one metastasis. Average tumor size was 31+-13mm. Infiltration was found in 49/61 (80%) with similar degrees across primary tumor type. In cases with infiltration, multiple cerebral metastases were present in 21/49 cases (43%). In cases without infiltration, the rate of multiple lesions was similar (5/12; 42%, p=0.94). In 27 patients, tumor size exceeded 30mm (47%) while 31 had smaller tumors (53%). Histological evidence of tumor infiltration was found in 25/31 in smaller lesions (81%) and 22/27 in larger lesions (82%, p=0.94).

Conclusion: Based on our prospective series, we could not confirm the hypothesis that infiltration of a metastatic tumor is associated with tumor size. Our data do not warrant altering the surgical strategy towards more aggressive transmarginal resection in larger lesions.