Die Rolle der Neurochirurgie in der Behandlung von Hirnmetastasen im Zeitalter molekularer Therapien:Ergebnisse der multizentrischen SUBARoMA Studie

Multicenter analysis of real-life care patterns of patients undergoing brain metastasis (BM) surgery and adjuvant treatment in the context of molecular therapies with the aim of confirming/refuting known predictors of local intracranial progression (LP) and overall survival (OS).

We conducted a retrospective, multicenter study (2012-2022) of patients who underwent surgery as initial treatment for their BM. Prognostically relevant parameters in relation to LP and OS were analyzed using the Kaplan-Meier method (univariate) and Cox regression model (multivariate).

We analyzed a total of 2657 patients (see Table 1 for the individual parameters).

Surgery was classified as complete in 73% and significantly improved patients' overall KPS (p<0.001); postoperative morbidity rate was 20%.

Intracranial progression occurred in 1036 (38%) patients after a mean/median time of 8.9/ 5.7 months (range: 0.17-74.0).

Progression of the initially resected BM occurred in 19 %, distant progression in 25 % and LMD in 6 %.

The primary tumor type (PT), the time interval between PT and BM, active extracranial tumor, and the use of radio- and systemic therapy proved to be significant predictors of LP.

PT and radiotherapy remained independent predictors (for p-values and HR see Table 2).

After a mean/median survival time of 7.5/15.0 months (range: 0-129.3), 1659 (60%) patients had died. For the 38% of patients for whom the cause of death was known, systemic progress was the most common (63%).

Gender, age, PT, number of BM, and the presence of extracranial tumor, pre- and postoperative KPS, extent of resection and postoperative morbidity significantly influenced OS. Adjuvant radio- and systemic therapy showed the strongest influence on OS.

In the multivariate analysis, age, PT, number of BM, EOR as well as active extracranial tumor, postoperative KPS, radio- and systemic therapy remained independent predictors (for p-values and HR see Table 2).

The SUBARoMA study shows how the current treatment guidelines are implemented in practice and points to the prognostic importance of adjuvant radiotherapy and systemic therapy, including immunologic and targeted therapies. Furthermore, the prognostic relevance of postoperative KPS and the high morbidity rate emphasize the careful selection of patients to be treated surgically.