CLTR-02 OUTCOMES OF SURGICAL RESECTION IN PATIENTS WITH MORE THAN ONE BRAIN METASTASIS

Abstract

Historically, surgical resection was confined to patients with a single brain metastasis (BM). Currently, more effective systemic therapies give improved extracranial disease control, highlighting the need for intracranial symptom and disease control. Therefore, we evaluated outcomes of surgical resection as part of initial local management in patients with multiple BMs. A single center retrospective cohort study was performed. Primary outcome measure was overall survival (OS), the secondary outcome measures were intracranial progression-free survival (iPFS) and extracranial PFS (ePFS). Kaplan-Meier and Cox Proportional Hazards methods were used. Between 1-1-2010 and 31-12-2023, 613 patients underwent BM resection. Of these patients, 131 patients had more than one BM and were included in the study. Median OS was 10.6 months (95% CI: 7.3-14.0 months). Median iPFS was 5.3 months (95% CI: 4.0-6.6 months), median ePFS was 7.5 months (95% CI: 4.2-10.8 months). Patients with melanoma (HR 0.273, 95% CI: 0.110-0.675, p = 0.005), post-surgery stereotactic radiotherapy (HR 0.446, 95% CI: 0.264-0.753, p = 0.002), whole brain radiation therapy (HR 0.598, 95% CI: 0.358-0.997, p = 0.049), systemic treatment (HR 0.370, 95% CI: 0.230-0.595, p < 0.001) or a Karnofsky performance score (KPS) ≥ 70 (HR 0.201, 95% CI: 0.108-0.374, p < 0.001) had a statistically significant lower risk of death from any cause. Age was inversely correlated with mortality (HR 1.023, 95% CI 1.001-1.045, p = 0.036). Of patients with a KPS < 70 (n = 18), only one patient survived more than one year. In conclusion: surgical resection in selected patients with multiple BMs in a good clinical condition provides a meaningful OS and iPFS, possibly by creating a window of opportunity for SRT and systemic therapies.