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.