Multiplicity does not significantly affect outcomes in brain metastasis patients treated with surgery

Yang, Kaiyun; Gutiérrez, Enrique; Landry, Alexander P; Kalyvas, Aristotelis; Millesi, Matthias; Leite, M.C.N.A.; Jablonska, Paola Anna; Weiss, Jessica; Millar, B; Conrad, Tatiana; Laperrière, Normand; Bernstein, Mark; Zadeh, Gelareh; Shultz, David; Kongkham, Paul

doi:10.1093/noajnl/vdac022

Cited by 4 publications

(1 citation statement)

References 30 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rastogi et al reported that 80% of their study population had multiple brain lesions [ 14 ]. Yang et al have discussed in their paper that having multiple brain lesions has been considered a negative prognostic factor in patients having brain metastasis [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Brain Metastases in Adults: A Five-Year Observational Study From King Abdulaziz Medical City

AlTamimi¹,

AlJohani²,

Naaman³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundAs a well-documented fact, metastatic brain tumors are the most common cause of brain tumors in adults, with an incidence of 9-17%, based on various studies, although it was thought to be higher. The aim of this study was to describe recorded cases of metastatic brain tumors in the adult population of a tertiary care and oncology center in Jeddah, Saudi Arabia. MethodsThis study was conducted at King Abdulaziz Medical City (KAMC) at King Khalid Hospital in Jeddah, Saudi Arabia, including records from January 2016 to December 2020. The study implemented a retrospective cohort design to fulfill its aim. A data collection sheet containing demographic data such as age and gender, and information pertaining to the primary pathology, multiplicity, and survival outcome was used. ResultsA total number of 213 patients were enrolled in this study. Overall, 68.1% of the sample comprised of females. Approximately two-thirds (61.9%) of the patients' imaging results revealed multiplicity, whereas the remaining third (38.1%) had solitary lesions. The estimated overall survival median after the diagnosis of brain metastasis was six months (95% CI: 5.5-6.5). ConclusionWe recommend conducting a nationwide study to better understand the incidence in accordance to geographical and gender differences. We can further expand our research to include other institutes in Saudi Arabia, and include important predictors such as time from the diagnosis of primary pathology to brain metastasis, disease progression cost, and disease progression in the months prior to the patients' death.

show abstract

Section: Discussionmentioning

confidence: 99%

Brain Metastases in Adults: A Five-Year Observational Study From King Abdulaziz Medical City

AlTamimi¹,

AlJohani²,

Naaman³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

Multiple craniotomies in a single surgery — the resection of scattered brain metastases

et al. 2023

View full text Add to dashboard Cite

Patients with brain metastases (BM), who can benefit from resection of multiple scattered lesions, often will not be offered a procedure involving multiple craniotomies in one session due to the overall poor prognosis. However, carefully selected candidates may well benefit from the resection of multiple lesions using multiple craniotomies through a significantly shortened hospital stay, aggressive decompression, and rapid eligibility for adjuvant therapies. In this retrospective analysis, the records of patients, who were treated for multiple BM using one surgical session involving multiple craniotomies, were reviewed. A group of patients with multiple BM, whose surgery only involved one craniotomy, were assigned to a control group. Clinical and surgical characteristics, preoperative and postoperative Karnofsky Performance Scale (KPS), complication rate, preoperative tumor size, number of lesions, number of craniotomies, skin incisions, and intraoperative repositioning of patients were recorded. Thirty-three patients were included in the multiple-craniotomy group. Thirty patients underwent two craniotomies, while three cases involved three craniotomies. Seven patients (21%) were intraoperatively repositioned from a prone to a supine position, which required an average of 23.3 ± 9.3 min from wound closure to the following skin incision. Thirty-six patients with multiple BM and matching characteristics, who received only one craniotomy for the dominant lesion, served as the control group. No difference was detected in postoperative KPS (p = 0.269), complication rate (p = 0.612), rate of new postoperative neurological deficits (p = 0.278), length of intensive care unit (ICU) (p = 0.991), and hospital stay (p = 0.913). There was a significant difference in average preoperative tumor size (p = 0.002), duration of surgery (p < 0.001), and extent of resection (p = 0.002). In the age of personalized medicine, selected patient may benefit from a single surgery for BM using multiple craniotomies. This study shows no significant increase of the perioperative complication rate for surgeries with multiple craniotomies.

show abstract

Defining the role of surgery for patients with multiple brain metastases

Ersoy,

Brainman,

Coras

et al. 2024

J Neurooncol

View full text Add to dashboard Cite

Purpose To better define the role of surgery, we investigated survival and functional outcomes in patients with multiple brain metastases. Methods Pertinent clinical and radiological data of 131 consecutive patients (156 surgeries) were analyzed retrospectively. Results Surgical indications included mass effect (84.6%) and need for tissue acquisition (44.9%, for molecularly informed treatment: 10 patients). Major (i.e. CTCAE grade 3–5) neurological, surgical and medical complication were observed in 6 (3.8%), 12 (7.7%), and 12 (7.7%) surgical cases. Median preoperative and discharge KPS were 80% (IQF: 60–90%). Median overall survival (mOS) was 7.4 months. However, estimated 1 and 2 year overall survival rates were 35.6% and 25.1%, respectively. Survival was dismal (i.e. mOS ≤ 2.5 months) in patients who had no postoperative radio- and systemic therapy, or who incurred major complications. Multivariate analysis with all parameters significantly correlated with survival as univariate parameters revealed female sex, oligometastases, no major new/worsened neurological deficits, and postoperative radio- and systemic therapy as independent positive prognostic parameters. Univariate positive prognostic parameters also included histology (best survival in breast cancer patients) and less than median (0.28 cm3) residual tumor load. Conclusions Surgery is a reasonable therapeutic option in many patients with multiple brain metastases. Operations should primarily aim at reducing mass effect thereby preserving the patients’ functional health status which will allow for further local (radiation) and systemic therapy. Surgery for the acquisition of metastatic tissue (more recently for molecularly informed treatment) is another important surgical indication. Cytoreductive surgery may also carry a survival benefit by itself.

show abstract

Multiplicity does not significantly affect outcomes in brain metastasis patients treated with surgery

Cited by 4 publications

References 30 publications

Brain Metastases in Adults: A Five-Year Observational Study From King Abdulaziz Medical City

Brain Metastases in Adults: A Five-Year Observational Study From King Abdulaziz Medical City

Multiple craniotomies in a single surgery — the resection of scattered brain metastases

Defining the role of surgery for patients with multiple brain metastases

Contact Info

Product

Resources

About