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BM-27 ESTIMATING THE ADDITIONAL BENEFIT OF SURGICAL EXCISION TO STEREOTACTIC RADIOSURGERY IN THE MANAGEMENT OF METASTATIC BRAIN DISEASE
Journal article   Open access   Peer reviewed

BM-27 ESTIMATING THE ADDITIONAL BENEFIT OF SURGICAL EXCISION TO STEREOTACTIC RADIOSURGERY IN THE MANAGEMENT OF METASTATIC BRAIN DISEASE

Matthew Quigley, Nicholas Bello, Diana Jho, Russell Fuhrer, Stephen Karlovits and Farrel Buchinsky
Neuro-oncology (Charlottesville, Va.), v 16(suppl 5), pp v38-v38
01 Nov 2014
DOI: https://doi.org/10.1093/neuonc/nou240.27
url
https://academic.oup.com/neuro-oncology/article-pdf/16/suppl_5/v38/3596571/nou240.27.pdfView
Published, Version of Record (VoR) Open
url
https://doi.org/10.1093/neuonc/nou240.27View
Published, Version of Record (VoR) Open

Abstract

There are limited data on the benefits of surgical tumor excision plus stereotactic radiosurgery (SRS) in comparison to SRS alone for patients with oligometastatic brain disease. We conducted a retrospective cohort study of 162 consecutive patients, who were whole brain radiation therapy (WBXRT) naive, undergoing tumor excision + SRS boost (n = 49) or SRS alone (n = 113). Factors related to patient survival were determined by Cox regression; time-to-recurrence (TTR) was analyzed similarly but with robust residuals to account for clustering. The effect of complete resection + SRS boost on survival was further explored by 2:1 propensity score matching. The average age of the cohort was 65.3 years, 49.4% female, and included 260 brain tumors of which 119 tumors were solitary. Surgical patients were younger, had better performance status and less burden of disease compared to SRS alone. None of these differences were statistically significant; RPA class was significantly better in the SRS + boost group (p = .003, Mann-Whitney). Seventy three tumors recurred (28%). Factors related to TTR were radiation sensitive pathology (non renal or melanoma) (hazard ratio (HR) =.345, p = .0014), treatment volume (HR = 1.078, p = .0022) and complete tumor resection (HR = .371, p = .015). Factors related to survival were age (HR = 1.02, p = .037), ECOG performance score (HR= 1.9, p = .0001) and complete surgical excision (HR = .55, p = .01). Propensity score matched analysis of complete resection + SRS boost (n = 40) versus SRS alone (n = 80) yielded nearly identical results of improved survival with complete resection (HR = .52, p = .03). Incomplete tumor resection had both median survival and TTR equivalent to SRS alone. Complete surgical excision + SRS boost is associated with improved survival and reduced likelihood of tumor recurrence in comparison to SRS alone. These results were replicated in the propensity score analysis which matched surgical and non-surgical patients on factors known to influence outcome. Incomplete resection did not improve survival or TTR compared to SRS alone.

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Web of Science research areas
Clinical Neurology
Oncology
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