Comparison of neurosurgery combined brain radiotherapy versus neurosurgery alone for patients with brain metastases

Abstract

Objective To summarize the single ⁃ center experience on neurosurgery and neurosurgery combined radiotherapy of brain metastases, and determine factors for prolonged survival time after brain radiotherapy for patients undergoing neurosurgery for brain metastases. Methods A total of 141 adult patients diagnosed with brain metastases between January 1st, 2011 and December 31st, 2018 were included in this retrospective study, and were divided into neurosurgery group (n = 91) and neurosurgery combined radiotherapy group (n = 50). Clinical data, including patients' age, sex, diagnosis type of primary tumor, neurological symptoms, number and location of brain metastases, plans of brain treatment, systematic treatment and status of extracranial metastasis (ECM), were extracted retrospectively. Survival analysis, subgroup analysis and univariate log⁃rank and multivariate Cox analysis were applied to predict factors and prognosis scores. Results The major primary tumor types were non⁃small cell lung cancer and breast cancer. The patients included mainly had single and supratentorial lesions and neurological symptoms. The neurosurgery combined radiotherapy group had a statistically higher rate of local treatment of primary tumor (P = 0.018). Multivariate Cox analysis showed that female (RR = 0.209, 95%CI: 0.077-0.567; P = 0.002), age ≥ 65 years (RR = 2.994, 95%CI: 1.066-8.411; P = 0.037), non⁃small cell lung cancer (NSCLC; RR = 0.175, 95%CI: 0.062-0.496, P = 0.001) and infratentorial tumor (RR = 0.065, 95%CI: 0.009-0.462; P = 0.006) or supratentorial plus infratentorial metastases (RR = 0.130, 95%CI: 0.020-0.864; P = 0.035) were associated with prognosis. Compared with neurosurgery group, neurosurgery combined radiotherapy group had significantly prolonged median survival time (13.9 months vs. 21.9 months, P = 0.009). The prognosis score was defined accordingly: for patients with a prognosis score ＞ 4, those in neurosurgery combined radiotherapy group had a significantly prolonged survival time (29.6 months vs. 13.9 months, P = 0.023). Conclusions For patients with brain metastases, neurosurgery combined with radiotherapy can prolong survival time and female, age＜65 years, NSCLC and infratentorial tumor are associated with better prognoses. A prognosis score was defined in our study, whereby neurosurgery combined radiotherapy is recommended for post⁃operative patients with a prognosis score＞4. For patients with a prognosis score ≤ 4, local management should be designed on an individual basis.

doi：10.3969/j.issn.1672⁃6731.2021.03.007