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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Surgical resection of symptomatic brain metastases – impact on clinical status, adjuvant treatment and survival

Chirurgie bei Hirnmetastasen – Einfluss auf klinischen Zustand, adjuvante Therapie und Überleben

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  • presenting/speaker Stephanie T. Jünger - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
  • Martin Proescholdt - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Karl-Michael Schebesch - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Christian Doenitz - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Lukasz Rams - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Alexander Brawanski - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Christian Reinhardt - Universitätsklinikum Köln, Onkologie, Köln, Deutschland
  • Lars Plambeck - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
  • Maike Wittersheim - Universitätsklinikum Köln, Pathologie, Köln, Deutschland
  • Petra Schödel - Universitätsklinikum Regensburg, Neurochirurgie, Regensburg, Deutschland
  • Stefan Grau - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
  • Roland H. Goldbrunner - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV285

doi: 10.3205/20dgnc281, urn:nbn:de:0183-20dgnc2818

Published: June 26, 2020

© 2020 Jünger 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: Novel systemic targeted treatment strategies for various cancers have led to both an improved overall survival and increased incidence of brain metastases. We analyzed structure and quality of the interdisciplinary treatment and outcome of patients undergoing resection of symptomatic brain metastases in the context of these molecular treatment regimens.

Methods: We retrospectively analyzed patients receiving resection of at least one symptomatic BM between 2012 and 2019 at two large academic hospitals. Baseline clinical and treatment-related parameters were retrieved. Post-treatment survival was calculated using Kaplan-Meyer analysis. Prognostic factors were identified using multivariate Cox-regression.

Results: 806 patients were included. Primary tumors comprised lung cancer (n=333), breast cancer (n=126), melanoma (n=119), gastrointestinal (n= 77), kidney cancer (n=29) and others (n=122). Solitary BM occurred in 372 (46.15%), singular in 238 (29.53%) and multiple in 196 (24.32%) patients. Systemic disease status was controlled in 367 (45.53%). Postoperative radiotherapy was applied in 624 (77.42%) patients and systemic treatment was initiated in 372 (46.15%) patients. Treatment decision correlated with postoperative clinical status (p = 0.0001), which was improved significantly by surgery; median preoperative KPS of 80 (range: 20-100) increasing to 90 (range: 50-100) after surgery (p = 0.00001). Resulting in an alteration of RPA class allocation in 114 (14.14%) patients, 89 (11.04%) of which were improvements. Pre- and postoperative RPA allocation reliably predicted survival (p=0.0065). In multivariate regression analysis, poor clinical status, absence of systemic treatment and multiple metastases were strong negative predictors for survival (0.00001).

Conclusion: Resection of symptomatic BM improves clinical status and increases the likelihood of adjuvant systemic treatment leading to prolonged survival.