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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Did the overall survival of patients with cerebral metastases included in phase III studies improve?

Hat sich das Gesamtüberleben von Patienten mit cerebralen Metastasen in Phase III Studien signifikant verbessert?

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  • presenting/speaker Marcel Alexander Kamp - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Igor Fischer - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Hendrik-Jan Mijderwijk - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Marion Rapp - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Jan Frederick Cornelius - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Michael Sabel - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP184

doi: 10.3205/19dgnc520, urn:nbn:de:0183-19dgnc5209

Published: May 8, 2019

© 2019 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

Text

Objective: Since the 1970s, various phase III trials have been conducted to compare different treatment modalities of cerebral metastases. Therapeutic standards of cerebral metastases as well as the treatment of the primary tumours changed. However, it remains unclear if changes in the therapeutic protocols resulted in an improved overall survival (OS). The impact of a whole-brain radiation therapy (WBRT) in the treatment of patients with 1-4 cerebral metastases is still part of the ongoing debate. Aim of the present study was evaluate death rates (DR) in phase III trials and to analyse the impact of WBRT in patients with 1-4 metastases.

Methods: A systematic search of the pubmed-, embase- and Cochrane-databases was performed to identify all phase III trials involving therapy of patients with cerebral metastases. The DR (1 / (mean OS)2) were correlated with publication year.

Results: Totally, 53 phase III with totally 11,295 patients were identified fulfilling the inclusion criteria. Median OS was 5.7 years. However, studies showed a great heteroscedasticity. For the 22 studies analyzing over 3000 patients with 1–4 cerebral metastases, data were homoscedastic. Linear regression revealed a significant improvement of the DR. Furthermore, WBRT was associated with significant higher death rates (p=0.001).

Conclusion: Firstly, DR in phase III studies involving treatment of cerebral metastases showed a great heteroscedasticity but no significant improvement. Secondly, DR have significantly improved in those studies including patients with 1-4 cerebral metastases. Finally, WBRT was associated with significant higher death rates.