Universität zu Köln

Schoedel, Petra, Juenger, Stephanie T., Wittersheim, Maike, Reinhardt, Hans Christian, Schmidt, Nils-Ole, Goldbrunner, Roland, Proescholdt, Martin and Grau, Stefan ORCID: 0000-0002-9742-527X (2020). Surgical resection of symptomatic brain metastases improves the clinical status and facilitates further treatment. Cancer Med., 9 (20). S. 7503 - 7511. HOBOKEN: WILEY. ISSN 2045-7634

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Abstract

Background Brain metastases (BM) frequently cause focal neurological deficits leading to a reduced Karnofsky performance score (KPS). Since KPS is routinely used to guide the choice of adjuvant therapy, we hypothesized that improving KPS by surgical resection may improve the chance for adjuvant treatment and ultimately result in better survival. We therefore analyzed the course of a large cohort undergoing resection of symptomatic brain metastases in the context of further treatment and clinical outcome. Patients and methods In a bi-centric retrospective analysis we retrieved baseline, clinical, and treatment-related parameters of patients operated on BM between 2010 and 2019. Survival was calculated using Kaplan-Meier estimates; prognostic factors for survival were analyzed by Log-rank test and Cox proportional hazards. Results We included 750 patients with a median age of 61 (19-87) years. The functional status was significantly improved by surgical resection, with a median preoperative (KPS) of 80 (10-100) increasing to 90 (0-100) after surgery (P < .0001). Moreover, surgery improved the RTOG recursive partitioning analysis (RPA) class from III to I/II in 82 patients. Postoperative local radiotherapy and systemic treatment were associated with significantly longer survival (P < .0001 for each). Systemic treatment was provided significantly more frequently in patients with a fair postoperative clinical status (KPS >= 70;P < .0001). The postoperative clinical status, postoperative radiotherapy, systemic treatment, controlled systemic disease and < 4 BM were independent predictors for survival. Conclusion The resection of symptomatic BM may restore clinical status, so enhancing the likelihood of receiving adjuvant treatment, and therefore leading to improved overall survival.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schoedel, Petra UNSPECIFIED UNSPECIFIED UNSPECIFIED Juenger, Stephanie T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittersheim, Maike UNSPECIFIED UNSPECIFIED UNSPECIFIED Reinhardt, Hans Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Nils-Ole UNSPECIFIED UNSPECIFIED UNSPECIFIED Goldbrunner, Roland UNSPECIFIED UNSPECIFIED UNSPECIFIED Proescholdt, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Grau, Stefan UNSPECIFIED orcid.org/0000-0002-9742-527X UNSPECIFIED
URN:	urn:nbn:de:hbz:38-322440
DOI:	10.1002/cam4.3402
Journal or Publication Title:	Cancer Med.
Volume:	9
Number:	20
Page Range:	S. 7503 - 7511
Date:	2020
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	2045-7634
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PARTITIONING ANALYSIS RPA; PROGNOSTIC-FACTORS; SINGLE; RADIOSURGERY; RADIOTHERAPY; SURGERY Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32244