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The Impact of Postoperative Tumor Burden on Patients With Brain Metastases
Amir Kaywan Aftahy1, Melanie Barz1, Nicole Lange1
1Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
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.
Insights
Postoperative residual tumor burden (RTB) significantly impacts survival in adult patients with brain metastases. Achieving maximal cytoreduction, confirmed by MRI, is crucial for improving patient outcomes, irrespective of radiotherapy.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Brain metastases are increasingly recognized for their infiltrating behavior, challenging traditional views of well-defined lesions.
- The precise impact of postoperative residual tumor burden (RTB) and the extent of resection on patient outcomes remains insufficiently defined.
Purpose of the Study:
- To investigate the prognostic significance of postoperative residual tumor burden (RTB) in adult patients undergoing surgery for brain metastases.
- To determine optimal cutoff values for RTB and patient age associated with survival.
- To evaluate the influence of postoperative radiotherapy on survival in this patient cohort.
Main Methods:
- Retrospective analysis of 704 adult patients who underwent surgery for brain metastases between April 2007 and January 2020.
- Early postoperative MRI (<72 hours) was utilized for RTB segmentation.
- Survival analysis, including multivariate analysis and maximally selected log rank statistics, was performed.
Main Results:
- A total of 704 patients were included, with 69.2% achieving complete cytoreduction.
- Significant predictors of survival included Karnofsky Performance Status (KPS), age, and both pre- and postoperative tumor burden.
- Key survival cutoff points were identified: RTB of 1.78 cm³ (overall) and 0.28 cm³ (targeted metastasis), and age of 67 years. Postoperative radiotherapy significantly improved survival.
Conclusions:
- Postoperative residual tumor burden (RTB) is a critical prognostic factor for survival in patients with brain metastases.
- Maximal cytoreduction, verified by postoperative MRI, should be prioritized to enhance patient survival.
- The type of postoperative radiotherapy does not negate the importance of achieving maximal cytoreduction.
