Risk factors for in-brain local progression in elderly patients after resection of cerebral metastases

Christopher Munoz-Bendix,Christiane Von Sass,Michael Sabel,Jan Frederick Cornelius,Hendrik-Jan Mijderwijk,Hans-Jakob Steiger,Maxine Dibué-Adjei,Marcel A Kamp,Marion Rapp,Bernd Turowski

doi:10.1038/s41598-019-43942-9

Christopher Munoz-Bendix, Christiane Von Sass + Show 8 more

Open Access

https://doi.org/10.1038/s41598-019-43942-9

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Abstract

Intracranial metastases are the most frequent brain tumor with recurrence rates after treatment of around 40–60%. Age is still considered a determinant of treatment and prognosis in this pathology. Recent studies analyzing the impact of metastasectomy in elderly patients focused on reporting perioperative mortality and morbidity rates but not on the evaluation of oncological outcome parameters. Aim of this study is to determine risk factors for in-brain local recurrence after brain surgery in this sub-population. From October 2009 until September 2016 all patients aged 65 years and above with histopathologically confirmed metastasis after surgical resection were retrospectively studied. Clinical, radiological and perioperative information was collected and statistically analysed. Follow-up consisted of clinical and radiological assessment every 3-months following surgery. 78 patients were included, of these 50% were female (39 patients). Median age was 71 years (66–83). Early postoperative-MRI verified a complete surgical resection in 41 patients (52.6%) and showed a tumor-remnant in 15 patients (19.2%). In 22 patients the MRI result was inconclusive (28.2%). None of the patients experienced severe complications due to surgery. The median postoperative NIHSS was adequate 1 ± 1.4 (0–6), nonetheless, insignificantly improved in comparison to the preoperative NIHSS (p = 0.16). A total of 20 patients (25.6%) presented local recurrence. The only statistically significant factor for development of local in-brain recurrence after resection of cerebral metastases in patients above 65 years of age was a tumor-remnant in the early postoperative MRI (p = 0.00005). Median overall survival was 13 months. Local in-brain recurrence after surgical resection of a cerebral metastasis in patients above 65 years of age was 25.6%. In our analysis, tumor-remnant in early postoperative MRI is the only risk factor for local in-brain recurrence. Oncological parameters in the present cohort do not seem to differ from recent phase III studies with non-geriatric patients. Nevertheless, controlled studies on the impact of metastasectomy in elderly patients delivering high quality reliable data are required.

Highlights

The exact incidence of cerebral metastases from solid cancers is unknown, intracerebral metastases are the most frequent brain tumors with a 3–5 times higher incidence than newly diagnosed primary malignant brain tumors each year[1,2]
Recent studies analyzing the impact of metastasectomy in elderly patients focused on reporting perioperative mortality and morbidity rates but not on evaluation of oncological outcome parameters
We retrospectively studied and analysed medical records and their corresponding radiological diagnostic tests of every patient presenting with histologically confirmed brain metastases from October 2009 until September 2016

Summary

Introduction

The exact incidence of cerebral metastases from solid cancers is unknown, intracerebral metastases are the most frequent brain tumors with a 3–5 times higher incidence than newly diagnosed primary malignant brain tumors each year[1,2]. Age above 60 years was one major risk factor for impaired overall survival (OS) in an early prospective randomized study comparing combined treatment of surgery and adjuvant whole-brain radiation therapy (WBRT) with an exclusive WBRT4. Www.nature.com/scientificreports without WBRT for 1 to 4 cerebral metastases suggested that age might be a factor influencing the efficiency of an adjuvant WBRT following SRS. For patients

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