Tumor-associated epilepsy in patients with brain metastases: necrosis-to-tumor ratio forecasts postoperative seizure freedom

Abstract

Surgical resection is highly effective in the treatment of tumor-related epilepsy (TRE) in patients with brain metastases (BM). Nevertheless, some patients suffer from postoperative persistent epilepsy which negatively impacts health-related quality of life. Therefore, early identification of patients with potentially unfavorable seizure outcome after BM resection is important. Patients with TRE that had undergone surgery for BM at the authors’ institution between 2013 and 2018 were analyzed with regard to preoperatively identifiable risk factors for unfavorable seizure outcome. Tumor tissue and tumor necrosis ratios were assessed volumetrically. According to the classification of the International League Against Epilepsy (ILAE), seizure outcome was categorized as favorable (ILAE 1) and unfavorable (ILAE 2–6) after 3 months in order to avoid potential interference with adjuvant cancer treatment. Among all 38 patients undergoing neurosurgical treatment for BM with concomitant TRE, 34 patients achieved a favorable seizure outcome (90%). Unfavorable seizure outcome was significantly associated with larger tumor volumes (p = 0.012), a midline shift > 7 mm (p = 0.025), and a necrosis/tumor volume ratio > 0.2 (p = 0.047). The present study identifies preoperatively collectable risk factors for unfavorable seizure outcome in patients with BM and TRE. This might enable to preselect for highly vulnerable patients with postoperative persistent epilepsy who might benefit from accompanying neuro-oncological expertise during further systemical treatment regimes.

Preoperative MRI‐Based Radiomics of Brain Metastasis to Assess T790M Resistance Mutation After EGFR‐TKI Treatment in NSCLC

“…Deep learning‐based algorithms for automatic detection and segmentation of BM can be reproducible, consistent, and efficient and should be addressed in our future work. Finally, the necrosis/tumor ratio and edema/tumor ratio have been reported to be important radiological features with strong influence on diagnosis and prognosis of BM 40 but these were not analyzed in our study.…”

Prevalence and risk factors of early postoperative seizures in patients with glioma: A protocol for meta-analysis and systematic review

“…Dewan et al [ 26 ] showed that patients without a history of preoperative early postoperative seizures were still prone to seizures after craniotomy, with an incidence rate of 7% to 18%. Therefore, a history of seizures before brain tumor surgery is an important risk factor for early seizure development after craniotomy [ 27 ]. The pathogenesis of mesenchymal tumor with early postoperative seizures is very complex and has not been fully elucidated.…”

Association of CDKN2A alterations with increased postoperative seizure risk after resection of brain metastases

“…Although postoperative antiseizure prophylaxis is generally given to minimize the risk of persistent or new postoperative seizures, the seizures may persist in a significant portion of patients. 4,8,9 Identification of at-risk patients based on genomic alterations may help guide antiseizure therapy in this population. Although previous work has explored clinical risk factors for postoperative seizures and a small number of molecular variables such as KRAS and EGFR mutation status have been explored, 8 there has yet to be a more comprehensive analysis of genomic alterations that correlate with seizures in the postoperative period.…”

“…presenting with seizures, resection can offer favorable seizure control in up to 90% of cases. 4 Resection of BMs can furthermore confirm a pathological diagnosis, and genomic testing of resected BMs can facilitate targeted therapies, which improve overall survival. [5][6][7] BM genomic sequenc-ABBREVIATIONS BM = brain metastasis; NSCLC = non-small cell lung cancer; RF = random forest; WBRT = whole-brain radiation therapy.…”