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Title:

The Impact of Postoperative Tumor Burden on Patients With Brain Metastases.

Document type:
Journal Article
Author(s):
Aftahy, Amir Kaywan; Barz, Melanie; Lange, Nicole; Baumgart, Lea; Thunstedt, Cem; Eller, Mario Antonio; Wiestler, Benedikt; Bernhardt, Denise; Combs, Stephanie E; Jost, Philipp J; Delbridge, Claire; Liesche-Starnecker, Friederike; Meyer, Bernhard; Gempt, Jens
Abstract:
BACKGROUND: Brain metastases were considered to be well-defined lesions, but recent research points to infiltrating behavior. Impact of postoperative residual tumor burden (RTB) and extent of resection are still not defined enough. PATIENTS AND METHODS: Adult patients with surgery of brain metastases between April 2007 and January 2020 were analyzed. Early postoperative MRI (<72 h) was used to segment RTB. Survival analysis was performed and cutoff values for RTB were revealed. Separate (subgroup) analyses regarding postoperative radiotherapy, age, and histopathological entities were performed. RESULTS: A total of 704 patients were included. Complete cytoreduction was achieved in 487/704 (69.2%) patients, median preoperative tumor burden was 12.4 cm3 (IQR 5.2-25.8 cm3), median RTB was 0.14 cm3 (IQR 0.0-2.05 cm3), and median postoperative tumor volume of the targeted BM was 0.0 cm3 (IQR 0.0-0.1 cm3). Median overall survival was 6 months (IQR 2-18). In multivariate analysis, preoperative KPSS (HR 0.981982, 95% CI, 0.9761-0.9873, p < 0.001), age (HR 1.012363; 95% CI, 1.0043-1.0205, p = 0.0026), and preoperative (HR 1.004906; 95% CI, 1.0003-1.0095, p = 0.00362) and postoperative tumor burden (HR 1.017983; 95% CI; 1.0058-1.0303, p = 0.0036) were significant. Maximally selected log rank statistics showed a significant cutoff for RTB of 1.78 cm3 (p = 0.0022) for all and 0.28 cm3 (p = 0.0047) for targeted metastasis and cutoff for the age of 67 years (p < 0.001). (Stereotactic) Radiotherapy had a significant impact on survival (p < 0.001). CONCLUSIONS: RTB is a strong predictor for survival. Maximal cytoreduction, as confirmed by postoperative MRI, should be achieved whenever possible, regardless of type of postoperative radiotherapy.
Journal title abbreviation:
Front Oncol
Year:
2022
Journal volume:
12
Fulltext / DOI:
doi:10.3389/fonc.2022.869764
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/35600394
Print-ISSN:
2234-943X
TUM Institution:
Institut für Allgemeine Pathologie und Pathologische Anatomie (Dr. Mogler komm.); Klinik und Poliklinik für Innere Medizin III, Hämatologie und Onkologie (Prof. Bassermann); Klinik und Poliklinik für Neurochirurgie (Prof. Meyer); Klinik und Poliklinik für RadioOnkologie und Strahlentherapie (Prof. Combs); Professur für AI for Image-Guided Diagnosis and Therapy (Prof. Wiestler); Professur für Neuroradiologie (Prof. Zimmer)
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