Surgery for brain metastases: radiooncology scores predict survival-score index for radiosurgery, graded prognostic assessment, recursive partitioning analysis

Background Radiooncological scores are used to stratify patients for radiation therapy. We assessed their ability to predict overall survival (OS) in patients undergoing surgery for metastatic brain disease. Methods We performed a post-hoc single-center analysis of 175 patients, prospectively enroll...

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Bibliographic Details
Published in:Acta neurochirurgica 2023-01, Vol.165 (1), p.231-238
Main Authors: Wolfert, Christina, Rohde, Veit, Hussein, Abdelhalim, Fiss, Ingo, Hernández-Durán, Silvia, Malzahn, Dörthe, Bleckmann, Annalen, Mielke, Dorothee, Schatlo, Bawarjan
Format: Article
Language:English
Subjects:
Brain
Brain cancer
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - radiotherapy
Brain Neoplasms - surgery
Humans
Interventional Radiology
Medicine
Medicine & Public Health
Metastases
Metastasis
Minimally Invasive Surgery
Neurology
Neuroradiology
Neurosurgery
Original - Tumor - Other
Original Article - Tumor - Other
Prognosis
Radiation therapy
Radiosurgery
Retrospective Studies
Surgery
Surgical Orthopedics
Survival
Tumor – Other
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Summary:Background Radiooncological scores are used to stratify patients for radiation therapy. We assessed their ability to predict overall survival (OS) in patients undergoing surgery for metastatic brain disease. Methods We performed a post-hoc single-center analysis of 175 patients, prospectively enrolled in the MetastaSys study data. Score index of radiosurgery (SIR), graded prognostic assessment (GPA), and recursive partitioning analysis (RPA) were assessed. All scores consider age, systemic disease, and performance status prior to surgery. Furthermore, GPA and SIR include the number of intracranial lesions while SIR additionally requires metastatic lesion volume. Predictive values for case fatality at 1 year after surgery were compared among scoring systems. Results All scores produced accurate reflections on OS after surgery ( p  ≤ 0.003). Median survival was 21–24 weeks in patients scored in the unfavorable cohorts, respectively. In cohorts with favorable scores, median survival ranged from 42 to 60 weeks. Favorable SIR was associated with a hazard ratio ( HR ) of 0.44 [0.29, 0.66] for death within 1 year. For GPA, the HR amounted to 0.44 [0.25, 0.75], while RPA had a HR of 0.30 [0.14, 0.63]. Overall test performance was highest for the SIR. Conclusions All scores proved useful in predicting OS. Considering our data, we recommend using the SIR for preoperative prognostic evaluation and counseling.
ISSN:0942-0940
0001-6268
0942-0940
DOI:10.1007/s00701-022-05356-x