Survival and prognostic factors in surgically treated brain metastases

Kavouridis, Vasileios K.; Harary, Maya; Hulsbergen, Alexander; Lo, Yu Tung; Reardon, David A.; Aizer, Ayal A.; Iorgulescu, J. Bryan; Smith, Timothy R.

doi:10.1007/s11060-019-03171-6

Cited by 36 publications

(32 citation statements)

References 45 publications

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“…As in the present series, diagnosis of multiple BM represents a predictive value for poor survival in various studies ( 11 – 13 ). Surgical resection only removes a part of the intracranial tumor burden, and the target area for postoperative radio/chemotherapy is larger, especially for radiosurgery, which in turn might be associated with an increased postinterventional risk ( 14 ).…”

Section: Discussionsupporting

confidence: 62%

“…In an elderly patient population with brain metastasis requiring surgery, this study identifies the presence of multiple BM, infratentorial location of BM, preoperatively elevated CRP levels, and frail condition of the patient as independent predictors of worse overall survival. As in the present series, diagnosis of multiple BM represents a predictive value for poor survival in various studies (11)(12)(13). Surgical resection only removes a part of the intracranial tumor burden, and the target area for postoperative radio/chemotherapy is larger, especially for radiosurgery, which in turn might be associated with an increased postinterventional risk (14).…”

Section: Discussionmentioning

confidence: 59%

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Outcome of Elderly Patients With Surgically Treated Brain Metastases

et al. 2021

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ObjectIn the light of an aging population and ongoing advances in cancer control, the optimal management in geriatric patients with brain metastases (BM) poses an increasing challenge, especially due to the scarce data available. We therefore analyzed our institutional data with regard to factors influencing overall survival (OS) in geriatric patients with BM.MethodsBetween 2013 and 2018, patients aged ≥ 65 years with surgically treated BM were included in this retrospective analysis. In search of preoperatively identifiable risk factors for poor OS, in addition to the underlying cancer, the preoperative frailty of patients was analyzed using the modified Frailty Index (mFI).ResultsA total of 180 geriatric patients with surgically treated BM were identified. Geriatric patients categorized as least-frail achieved a median OS of 18 months, whereas frailest patients achieved an OS of only 3 months (p<0.0001). Multivariable cox regression analysis detected “multiple intracranial metastases” (p=0.001), “infratentorial localization” (p=0.011), “preoperative CRP >5 mg/l” (p=0.01) and “frailest patients (mFI ≥ 0.27)” (p=0.002) as predictors for reduced OS in older patients undergoing surgical treatment for BM.ConclusionsIn this retrospective series, pre-operative frailty was associated with poor survival in elderly patients with BM requiring surgery. Our analyses warrant thorough counselling and support of affected elderly patients and their families.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 59%

Outcome of Elderly Patients With Surgically Treated Brain Metastases

et al. 2021

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“…We found that the median survival of patients with BM from sarcomas surgically treated was comparable to that from carcinomas [63]. Additionally, postoperative KPS was improved in 50% (11/22) of the patients and postoperative mortality was 0%.…”

Section: Discussionmentioning

confidence: 67%

Surgical outcome and graded prognostic assessment of patients with brain metastasis from adult sarcoma: multi-institutional retrospective study in Japan

et al. 2020

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Background: Little information is available about the feasibility and prognostic assessment of surgical resection of brain metastasis (BM) from sarcomas. We aimed to analyze functional and survival outcomes, and develop a preoperative graded prognostic assessment (GPA) for patients with BM from sarcomas to predict survival time after local resection surgery. Methods: This study involved a multiinstitutional retrospective analysis of 22 patients with BM from sarcomas who underwent resection at six institutes in Japan between September 2002 and September 2018.Overall survival (OS) after resection of BM was calculated by the Kaplan-Meier method. Prognostic factors were analyzed to develop a GPA using the log-rank test and Cox regression analysis. P < 0.05 was considered to indicate statistical significance. For GPA validation, we collected data on 100 patients from 48 published reports. Results: Postoperative Karnofsky Performance Status (KPS) was improved in 50% (11/22) of patients. Median OS was 21 months. Univariate analysis of OS showed that age (≥ 30 years old), gross total resection, and alveolar soft part sarcoma (ASPS) were significant positive prognostic factors (P<0.05). Multivariate analysis of OS showed age and ASPS were significant preoperative prognostic factors (P<0.05). RTOG-RPA classification had no significant prognostic value. We developed a GPA system for survival time after resection of BM in our patients. A score of 0 was assigned to patients aged 18-29 years with non-ASPS, a score of 2 to patients aged 18-29 years with ASPS or those aged 30-76 years with non-ASPS, and a score of 4 to patients aged 30-76 years with ASPS. Median OS for patients with GPA scores of 0, 2, and 4 were 6.5, 16.0, and 44.0 months, respectively (P=0.002). The results were validated by the survival data of 100 patients compiled from the literature (P<0.001). Conclusion: Patients with BM from sarcomas surgically treated showed median survival comparable to that of patients with BM from carcinomas,and showed improvement in postoperative KPS.We developed a new GPA of patients with BM from sarcomas. These results may help patients and clinicians to select resection as a feasible option for treating BM from sarcomas. Background Adult sarcomas are an uncommon, heterogeneous entity of solid tumors of mesenchymal origin with various distinct histological subtypes, accounting for 1% of all adult malignancies [1].

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“…Our results show that almost half (47.1%) of the patients treated with any combination of BRAF/MEK targeted therapy and immunotherapy develop intracranial disease in the setting of stable or improving extracranial disease, with only 52.9% having progressing extracranial disease at the time of clinical presentation. There is a difference in terms of survival in patients who have intracranial metastatic melanoma and lower functional status due to symptomatic disease compared to those with incidentally found disease [29]. In addition, the Graded Prognostic Assessment score for intracranial melanoma is lower, indicating lower median survival, for patients who are more severely symptomatic as evidenced by a lower Karnofsky Performance Scale [30].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Intracranial Melanoma Progression in the Setting of Positive Extracranial Response to Targeted Therapy and Immunotherapy: An Indication for More Frequent Screening in This Population?

Gattozzi

Rosso

Schatmeyer

et al. 2021

Cureus

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Background and objective The incidence of intracranial metastases from melanoma is on the rise. In this study, we aimed to determine the incidence of intracranial disease progression in patients on BRAF/MEK targeted therapy and immunotherapy in the setting of controlled or improving extracranial disease. Methods This was a single-center, retrospective review that involved patients who underwent stereotactic radiosurgery (SRS) for intracranial metastatic melanoma between January 1, 2014, and December 31, 2018. We focused on BRAF/MEK mutation status and dates of treatment with BRAF/MEK targeted therapy, immunotherapy [ipilimumab (Yervoy), nivolumab (Opdivo), or pembrolizumab (Keytruda)], and combination targeted and immunotherapy. Results A total of 51 patients were enrolled: 36 males and 15 females. The average age of the patients was 58.6 years, and 26 among them were BRAF mutation-positive. Seventeen had prior surgery with SRS as adjuvant therapy. The other 34 had SRS as primary treatment. Forty-two patients had extracranial disease present at the time of SRS. There were 34 patients treated with targeted and immune therapy. Overall, 16 patients (47.1%) demonstrated controlled or improving extracranial disease, and 18 (52.9%) demonstrated progressing extracranial disease at the time of SRS. In the subgroup analysis, patients treated with BRAF/MEK targeted therapy demonstrated a 75% rate of extracranial disease control. The extracranial disease was controlled in 43.75% of patients on immunotherapy with intracranial progression, while it was controlled in 30% of patients on both BRAF/MEK targeted therapy and immunotherapy with intracranial progression. Sixteen patients (47.1%) developed intracranial metastasis in our study while having a stable systemic disease with BRAF/MEK targeted therapy, immunotherapy, or a combination of the two. Conclusion Based on our findings, a systemic response to targeted therapy and immunotherapy does not necessarily parallel intracranial protection.

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Survival and prognostic factors in surgically treated brain metastases

Cited by 36 publications

References 45 publications

Outcome of Elderly Patients With Surgically Treated Brain Metastases

Outcome of Elderly Patients With Surgically Treated Brain Metastases

Surgical outcome and graded prognostic assessment of patients with brain metastasis from adult sarcoma: multi-institutional retrospective study in Japan

Incidence of Intracranial Melanoma Progression in the Setting of Positive Extracranial Response to Targeted Therapy and Immunotherapy: An Indication for More Frequent Screening in This Population?

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