In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Impact of Surgical Resection in Patients with Multiple Brain Metastases

    Final Number:
    934

    Authors:
    Sherise D. Ferguson MD; Dima Suki PhD; Kathryn Wagner MD; Debra N Yeboa MD; Mary Fran McAleer MD, PHD; Raymond Sawaya MD; Amy B. Heimberger MD; Ian E. McCutcheon MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Brain metastases present a significant therapeutic challenge. Whereas data regarding the role of surgery for solitary metastasis is established, the impact of surgery in the setting of multiple brain metastases is less defined.

    Methods: An IRB-approved, retrospective chart review was conducted of patients with previously untreated multiple brain metastases who underwent resection of a single dominant brain lesion at MD Anderson Cancer Center between 1/1998 and 2/2016 to determine predictors of survival. Volumetric analysis of pre-operative and post-operative total tumor burden (cumulative volume) was performed. Post-operative percentage volume reduction was calculated. Univariate and multivariate analysis were performed.

    Results: Data on 274 patients were analyzed. Median patient age and pre-operative Karnofsky Performance Scale (KPS) score were 59 years and 90, respectively. Most common histologies were lung (32%), melanoma (23%) and breast (14%). At surgery, there was evidence of systemic disease in 64%. Median number of brain metastases was 2.5 (range, 2-10), with a median pre-operative cumulative tumor volume of 18.8 cm3. Median volume of the resected single dominant metastases was 15.7 cm3 and 94% of patients had a complete resection. Median total volume reduction was 92.4%. Median follow-up among alive patients was 36 months. 30-day perioperative mortality was 4%. 72% underwent post-operative radiation within 6 weeks of resection. Median Kaplan-Meier postoperative survival estimate was 7.7 months. Multivariate cox proportional hazard model revealed lower KPS, GI or melanoma primary, evidence of primary disease and larger pre-operative cumulative tumor volumes were negative predictors of survival. Postoperative radiation and increased surgical reduction of total tumor volume were found to be predictors of improved patient survival (all p<0.05).

    Conclusions: In addition to known prognostic factors (KPS, primary disease status, postoperative radiation), cumulative pre-operative tumor burden and surgical reduction of overall tumor volume significantly impacted the survival of patients with multiple brain metastases.

    Patient Care: This research will assist in surgical decision making for patients with multiple brain metastases

    Learning Objectives: By the conclusion of this session participants should be able to: 1) Discuss the role of surgery in patients with multiple brain metastases 2). Describe the impact of cumulative tumor volume on patient outcome.

    References:

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy