Outcome Improvement in RPA I or II Patients With 1 or 2 Brain Metastases by Combined Surgery and Radiotherapy

Abstract

Background: To evaluate the role of surgery and postoperative radiotherapy in the management of brain metastases (BM): a retrospective analysis for overall survival (OS), local and brain control (LC and BC) of a series of 329 patients with recursive partitioning analysis (RPA) I or II with 1 or 2 BM in a single institution.

Methods: Patients were treated either with combined surgical resection and whole brain radiation therapy (WBRT) in 104 cases (31.6%) or with WBRT alone in 225 cases (68.4%). Ninety-five patients (91.4%) who underwent surgery and WBRT and 147 (65.3%) who underwent WBRT alone benefited from a radiation boost to the metastatic site.

Results: The median OS was higher for patients RPA I compared to RPA II: 21.3 and 5.9 months (P < 0.0001), as well as for the surgical group compared to the radiation group: 20.2 vs 5.3 months (P < 0.0001), respectively. After the multivariate analysis, the improvedOS was significantly associated with control of primary tumor (P 0.0002) after surgical resection and with type of primary tumor (P 0.002), absence of extracranial metastases (ECM) (P 0.006), and high Karnofsky performance status (90 - 100 vs 70 - 80) (P 0.003) after radiotherapy alone. The 12-, 24- and 36-months LC rates were 91.1%, 91.1% and 83.9%, respectively, after surgical resection and 81.2%, 63.1% and 57.3%, respectively, after radiotherapy alone (P 0.005). In a univariate analysis, improved LC for the surgical group was also associated with the absence of ECM (P 0.01) and for the radiation group, with a radiation boost (P 0.01). The BC rates at 12, 24 and 36 months were 73.2%, 66.9% and 56%, respectively, in the surgical group and 75.7%, 49.6% and 42.4%, respectively, in the radiation group (P 0.2). In our univariate analysis, improved BC after surgical resection was associated with control of primary tumor (P 0.02). For patients in the radiation group, gender (P 0.03) and a radiation boost (P 0.0003) were significant prognostic factors in a univariate analysis. In our multivariate analysis, only the radiation boost was significant (P 0.001).

Conclusions: Surgical resection followed by WBRT leads to a better outcome compared to WBRT alone for RPA I or II patients with 1 or 2 BM.



World J Oncol. 2013;4(1):37-45
doi: https://doi.org/10.4021/wjon626w