The Impact of Postoperative Tumor Burden on Patients With Brain Metastases
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The Impact of Postoperative Tumor Burden on Patients With Brain Metastases. / 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.
in: FRONT ONCOL, Jahrgang 12, 2022, S. 869764.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - The Impact of Postoperative Tumor Burden on Patients With Brain Metastases
AU - Aftahy, Amir Kaywan
AU - Barz, Melanie
AU - Lange, Nicole
AU - Baumgart, Lea
AU - Thunstedt, Cem
AU - Eller, Mario Antonio
AU - Wiestler, Benedikt
AU - Bernhardt, Denise
AU - Combs, Stephanie E
AU - Jost, Philipp J
AU - Delbridge, Claire
AU - Liesche-Starnecker, Friederike
AU - Meyer, Bernhard
AU - Gempt, Jens
N1 - Copyright © 2022 Aftahy, Barz, Lange, Baumgart, Thunstedt, Eller, Wiestler, Bernhardt, Combs, Jost, Delbridge, Liesche-Starnecker, Meyer and Gempt.
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
U2 - 10.3389/fonc.2022.869764
DO - 10.3389/fonc.2022.869764
M3 - SCORING: Journal article
C2 - 35600394
VL - 12
SP - 869764
JO - FRONT ONCOL
JF - FRONT ONCOL
SN - 2234-943X
ER -