Re-resection of brain metastases – Outcomes of an institutional cohort study and literature review
Author:
Wasilewski David1, Shaked Zoe1, Fuchs Annalena1, Roohani Siyer2, Xu Ran1, Schlaak Max3, Frost Nikolaj3, Misch Martin1, Capper David3, Kaul David1, Onken Julia1, Vajkoczy Peter1, Ehret Felix1
Affiliation:
1. Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin 2. Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy 3. Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center
Abstract
Abstract
Background: Surgically accessible brain metastases are treated with microsurgical removal followed by radiation therapy, resulting in improved progression-free and overall survival. Some patients experience recurrence, prompting the need for effective management strategies. Despite the prevalence of recurrence, there remains a gap in the literature regarding the outcomes of patients that experience intracranial disease recurrence necessitating re-resection of a brain metastasis.
Objectives: This study aims to comprehensively characterize clinical, radiological, histopathological, and treatment-related aspects, along with outcomes, for patients undergoing re-resection of locally and distantly recurrent brain metastases.
Methods: We conducted a single-center retrospective cohort study, focusing on patients who underwent a second brain metastasis resection following prior removal and irradiation.
Results: Among the 60 patients undergoing re-resection, local recurrence was observed in 41 patients (68.3%), while 19 (31.7%) showed distant recurrence. Median intracranial progression-free survival was 7.7 months (6.5-11.2; IQR), with a median time-to-recurrence resection of 11.6 months (9.07-15.3; IQR), and a median overall survival of 30.8 months (20.4 – 51.6; IQR). Non-small cell lung cancer (NSCLC) represented the most common tumor entity. Following initial brain metastasis resection, treatment comprised radiation therapy alone for 18 patients (31.7%), radiation and chemotherapy for 15 patients (25.0%), radiation with targeted therapy for 9 patients (15.0%), and radiation with immunotherapy for 17 patients (28.3%). While 46 patients (76.7%) received irradiation to the resection cavity, 14 patients underwent whole brain radiation (24.3%). Independent risk factors for shorter overall survival included the presence of NSCLC or small cell lung cancer. Adjuvant radiation therapy together with checkpoint inhibition was associated with improved intracranial progression-free survival.
Conclusion: Brain metastases resection of local and distant recurrences is feasible and is a valuable option for selected patients. Further research to improve patient selection and treatment algorithms is warranted.
Publisher
Research Square Platform LLC
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