OS02.4.A IMPACT OF SURGERY ON SURVIVAL IN PATIENTS WITH MULTIPLE BRAIN METASTASES

Abstract

Abstract BACKGROUND Surgical resection of brain metastases (BM) alleviates symptoms and can improve patients’ survival. However, the benefit of resection in multiple BM is controversial due to patients’ limited life expectancy. Therefore, we investigated the impact of resection of multiple BM on patients’ survival. MATERIAL AND METHODS We reviewed clinical data from 544 patients (216 female, 328 male) who underwent surgery for BM in our hospital between 2010 and 2022. Overall survival (OS) was estimated using the Kaplan-Meier estimator. In addition, follow-up data, adjuvant treatment and tumor recurrence data were collected. RESULTS We identified 280 patients (51.5%) with one and 264 patients (48.5%) with two or more BM. Bronchial carcinoma represented the most common primary tumor entity (n= 185, 88 one and 97 multiple BM), followed by melanoma (n= 109, 44 one and 65 multiple BM), breast cancer (n= 54, 31 one and 23 multiple BM), gastro-intestinal tumor (n= 64, 39 one and 25 multiple BM) and lastly cancer of unknown primary (CUP) (n= 29, 11 one and 18 multiple BM). We then compared the survival between patients with a single with those with multiple BM. The median OS of all patients with one BM was with 11.6 months significantly longer than those with two or more BM (7.3 months, p< 0.001, 95% CI one vs. multiple BM: 8.6-14.5 vs. 6.2-8.4 months, respectively). Notably, 29.3% of patients with one BM and 16.5% with multiple BM lived longer than 24 months after resection (long-term survivor, p= 0.001). Regarding primary tumor histology, patients with breast cancer with a single BM had a significant longer OS with 19.7 compared to patients with multiple BM (5.0 months, p= 0.031). Remarkably, 33.3% of all long-term survivors with breast cancer had multiple BM. Patients with a single BM originating from other cancers showed a superior but yet not significant OS in comparison with their counterparts with multiple BM after resection. This included: gastro-intestinal cancer 12.2 vs. 6.5 months (p= 0.160), melanoma 11.6 vs. 7.3 months (p= 0.236) and CUP 3.0 vs. 2.7 months (p= 0.258). The long-term survivor rate of patients with resected multiple BM varied between 20.6% in melanoma and 7.4% in patients with CUP. CONCLUSION Despite limited prognosis in patients with multiple BM, surgical resection should be considered as an effective treatment option. Our study shows that a substantial subset of patients with multiple BM who underwent resection survive longer than 24 months after resection.