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Abstractvortrag | Abstract talk
V231

Zytoreduktion der Resttumorlast ist ausschlaggebend für ein längeres Überleben bei Patienten mit rezidivierenden Hirnmetastasen - Retrospektive Analyse von 219 Patienten

Cytoreduction of residual tumor burden is decisive for prolonged survival in patients with recurrent brain metastases – Retrospective analysis of 219 patients

Termin

Datum: Mi, 12.06.2024

Zeit: 09:30 – 09:40

Redezeit: 7 Min.

Diskussionszeit: 3 Min.

Ort / Stream:

Gleis 2

Session

Tumor – Metastasen

Thema

Tumor

Mitwirkende

Jonas Lin (München), Yannik Kaiser (München), Benedikt Wiestler (München), Denise Bernhardt (München), Stephanie E. Combs (München), Claire Delbridge (München), Bernhard Meyer (München), Jens Gempt (München; Hamburg), Amir Kaywan Aftahy (München)

Abstract

Despite advances in treatment for brain metastases (BMs), the prognosis for recurrent BMs remains poor and requires further research to advance clinical management and improve patient outcomes. Particularly, data addressing the impact of tumor volume and surgical resection with regards to survival remain scarce.

Adult patients with recurrent BMs between 12/2007-12/2022 were analyzed. A distinction was made between operated and non-operated patients and the residual tumor burden (RTB) was determined by (postoperative) MRI. Survival analysis was performed and RTB cut-off values were calculated using maximally selected log rank statistics. In addition, further analyses on systemic tumor progression and (postoperative) tumor therapy were conducted.

219 patients were included in the analysis. Median age at was 60 years (IQR 52-69). Median preoperative tumor burden was 2.4 cm³ (IQR 0.8-8.3), and postoperative tumor burden was 0.5 cm³ (IQR 0.0-2.9). 95 patients (43.4%) underwent surgery and complete cytoreduction was achieved in 55 (25.1%) patients. Median overall survival was 6 months (IQR 2-10). Cutoff RTB in all patients was 0.12 cm³, showing significant difference (p = 0.00029) in overall survival (OS). Multivariate analysis has shown preoperative KPSS (HR 0.983, 95% CI, 0.967-0.997, p = 0.015), postoperative tumor burden (HR 1.03, 95% CI 1.008-1.053, p = 0.007) and complete vs. incomplete resection (HR 0.629, 95% CI 0.420-0.941, p = 0.024) as significant. Longer survival was significantly associated with surgery for recurrent BMs (p = 0.00097) and additional analysis demonstrated the significant effect of complete resection on survival (p = 0.0027). In the subgroup of patients with systemic progression, a cutoff RTB of 0.97 cm³ (p = 0.00068) was found; patients who had received surgery also showed prolonged OS (p = 0.036). Single systemic therapy (p = 0.048) and the combination of radiotherapy and systemic therapy had significant influence on survival (p = 0.036).

RTB is a strong prognostic factor for survival in patients with recurrent BMs. Operated patients with recurrent BMs showed longer survival independent of systemic progression. Maximal cytoreduction should be targeted to achieve better long-term outcomes.