Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting
Abstract Background Treatment decision for recurrent symptomatic brain metastases (BM) is challenging with scarce data regarding surgical resection. We therefore evaluated the efficacy of surgery for pretreated, recurrent BM in a comprehensive multidisciplinary treatment setting. Methods In a retros...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-022-09317-6 |
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| author | Nadine Heßler Stephanie T. Jünger Anna-Katharina Meissner Martin Kocher Roland Goldbrunner Stefan Grau |
| author_facet | Nadine Heßler Stephanie T. Jünger Anna-Katharina Meissner Martin Kocher Roland Goldbrunner Stefan Grau |
| author_sort | Nadine Heßler |
| collection | DOAJ |
| description | Abstract Background Treatment decision for recurrent symptomatic brain metastases (BM) is challenging with scarce data regarding surgical resection. We therefore evaluated the efficacy of surgery for pretreated, recurrent BM in a comprehensive multidisciplinary treatment setting. Methods In a retrospective single center study, patients were analyzed, who underwent surgical resection of recurrent BM between 2007 and 2019. Intracranial event-free survival (EFS) and overall survival (OS) were evaluated by Kaplan-Maier and Cox regression analysis. Results We included 107 patients with different primary tumor entities and individual previous treatment for BM. Primary tumors comprised non-small cell lung cancer (NSCLC) (37.4%), breast cancer (19.6%), melanoma (13.1%), gastro-intestinal cancer (10.3%) and other, rare entities (19.6%). The number of previous treatments of BM ranged from one to four; the adjuvant treatment modalities comprised: none, focal or whole brain radiotherapy, brachytherapy and radiosurgery. The median pre-operative Karnofsky Performance Score (KPS) was 70% (range 40–100) and improved to 80% (range 0-100) after surgery. The complication rate was 26.2% and two patients died during the perioperative period. Sixty-seven (62.6%) patients received postoperative local radio-oncologic and/or systemic therapy. Median postoperative EFS and OS were 7.1 (95%CI 5.8–8.2) and 11.1 (95%CI 8.4–13.6) months, respectively. The clinical status (postoperative KPS ≥ 70 (HR 0.27 95%CI 0.16–0.46; p < 0.001) remained the only independent factor for survival in multivariate analysis. Conclusions Surgical resection of recurrent BM may improve the clinical status and thus OS but is associated with a high complication rate; therefore a very careful patient selection is crucial. |
| first_indexed | 2024-12-14T18:44:09Z |
| format | Article |
| id | doaj.art-fa30aadf84924ba5a949c9583bf276c0 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-14T18:44:09Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-fa30aadf84924ba5a949c9583bf276c02022-12-21T22:51:26ZengBMCBMC Cancer1471-24072022-03-012211610.1186/s12885-022-09317-6Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment settingNadine Heßler0Stephanie T. Jünger1Anna-Katharina Meissner2Martin Kocher3Roland Goldbrunner4Stefan Grau5Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of CologneCenter for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of CologneCenter for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of CologneCenter for Neurosurgery, Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of CologneCenter for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of CologneCenter for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of CologneAbstract Background Treatment decision for recurrent symptomatic brain metastases (BM) is challenging with scarce data regarding surgical resection. We therefore evaluated the efficacy of surgery for pretreated, recurrent BM in a comprehensive multidisciplinary treatment setting. Methods In a retrospective single center study, patients were analyzed, who underwent surgical resection of recurrent BM between 2007 and 2019. Intracranial event-free survival (EFS) and overall survival (OS) were evaluated by Kaplan-Maier and Cox regression analysis. Results We included 107 patients with different primary tumor entities and individual previous treatment for BM. Primary tumors comprised non-small cell lung cancer (NSCLC) (37.4%), breast cancer (19.6%), melanoma (13.1%), gastro-intestinal cancer (10.3%) and other, rare entities (19.6%). The number of previous treatments of BM ranged from one to four; the adjuvant treatment modalities comprised: none, focal or whole brain radiotherapy, brachytherapy and radiosurgery. The median pre-operative Karnofsky Performance Score (KPS) was 70% (range 40–100) and improved to 80% (range 0-100) after surgery. The complication rate was 26.2% and two patients died during the perioperative period. Sixty-seven (62.6%) patients received postoperative local radio-oncologic and/or systemic therapy. Median postoperative EFS and OS were 7.1 (95%CI 5.8–8.2) and 11.1 (95%CI 8.4–13.6) months, respectively. The clinical status (postoperative KPS ≥ 70 (HR 0.27 95%CI 0.16–0.46; p < 0.001) remained the only independent factor for survival in multivariate analysis. Conclusions Surgical resection of recurrent BM may improve the clinical status and thus OS but is associated with a high complication rate; therefore a very careful patient selection is crucial.https://doi.org/10.1186/s12885-022-09317-6Recurrent brain metastasisRadio-oncological treatmentOverall survival |
| spellingShingle | Nadine Heßler Stephanie T. Jünger Anna-Katharina Meissner Martin Kocher Roland Goldbrunner Stefan Grau Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting BMC Cancer Recurrent brain metastasis Radio-oncological treatment Overall survival |
| title | Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting |
| title_full | Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting |
| title_fullStr | Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting |
| title_full_unstemmed | Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting |
| title_short | Recurrent brain metastases: the role of resection of in a comprehensive multidisciplinary treatment setting |
| title_sort | recurrent brain metastases the role of resection of in a comprehensive multidisciplinary treatment setting |
| topic | Recurrent brain metastasis Radio-oncological treatment Overall survival |
| url | https://doi.org/10.1186/s12885-022-09317-6 |
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