Abstract
Simple SummaryIn this monocentric retrospective analysis, the extent of resection of singular/solitary brain metastases has no impact on local recurrence and overall survival rates in patients receiving multidisciplinary adjuvant treatment. Since systemic disease progression is the leading cause of death, and an uncontrolled systemic disease status, along with adjuvant treatment, present independent predictors of overall survival, a comprehensive, multidisciplinary treatment concept is essential for patients with brain metastases.Background and Purpose: The value of gross-total surgical resection remains debatable in patients with brain metastases (BMs) as most patients succumb to systemic disease progression. In this study, we evaluated the impact of the extent of resection of singular/solitary BM on in-brain recurrence (iBR), focusing on local recurrence (LR) and overall survival (OS) in an interdisciplinary adjuvant treatment setting. Patients and Methods: In this monocentric retrospective analysis, we included patients receiving surgery of one BM and subsequent adjuvant treatment. A radiologist and a neurosurgeon determined in consensus the extent of resection based on magnetic resonance imaging. The OS was calculated using Kaplan–Meier estimates; prognostic factors for LR and OS were analysed by Log rank test and Cox proportional hazards. Results: We analyzed 197 patients. Gross-total resection was achieved in 123 (62.4%) patients. All patients were treated with adjuvant radiotherapy, and 130 (66.0%) received systemic treatment. Ninety-six (48.7%) patients showed iBR with an LR rate of 23.4%. LR was not significantly influenced by the extent of resection (p = 0.139) or any other parameter. The median OS after surgery was 18 (95%CI 12.5–23.5) months. In univariate analysis, the extent of resection did not influence OS (p = 0.6759), as opposed to adjuvant systemic treatment (p < 0.0001) and controlled systemic disease (p = 0.039). Systemic treatment and controlled disease status remained independent factors for OS (p < 0.0001 and p = 0.009, respectively). Conclusions: In this study, the extent of resection of BMs neither influenced the LR nor the OS of patients receiving interdisciplinary adjuvant treatment.
Highlights
With improvements in systemically-active anti-cancer therapies and due to the availability of more sophisticated diagnostic techniques, the number of patients diagnosed with brain metastases (BMs) is steadily increasing [1,2,3]
We retrospectively reviewed our internal database at our tertiary care medical centre for patients aged >18 years, who received surgery for a single BM and interdisciplinary adjuvant treatment from 2010 to 2019
The times to in-brain recurrence (iBR) and overall survival (OS) were calculated from the date of BM resection until intracerebral progression on magnetic resonance imaging (MRI) and death/last follow-up, respectively
Summary
With improvements in systemically-active anti-cancer therapies and due to the availability of more sophisticated diagnostic techniques, the number of patients diagnosed with brain metastases (BMs) is steadily increasing [1,2,3]. Studies demonstrated a significantly improved overall survival (OS) for patients with BMs receiving surgical resection plus adjuvant whole brain radiation therapy (WBRT) compared to WBRT alone [5,6]. These studies were conducted in a preradiosurgical era and before magnetic resonance imaging (MRI) was widely available. The value of gross-total surgical resection remains debatable in patients with brain metastases (BMs) as most patients succumb to systemic disease progression. Conclusions: In this study, the extent of resection of BMs neither influenced the LR nor the OS of patients receiving interdisciplinary adjuvant treatment
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