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J Neurol Surg A Cent Eur Neurosurg 2021; 82(03): 211-217
DOI: 10.1055/s-0040-1714410
Original Article

Surgical Indication Optimization of Brain Metastases Based on the Evolutionary Analysis of Karnofsky Performance Status

Jorge Rasmussen 
1   Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
,
Pablo Ajler
1   Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
,
Daniela Massa
1   Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
,
Pedro Plou
1   Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
,
Matteo Baccanelli
1   Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
,
Claudio Yampolsky
1   Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Abstract

Background and Objective Surgical resection of brain metastases (BM) offers the highest rates of local control and survival; however, it is reserved for patients with good functional status. In particular, the presence of BM tends to oversize the detriment of the overall functional status, causing neurologic deterioration, potentially reversible following symptomatic pharmacological treatment. Thus, a timely indication of surgical resection may be dismissed. We propose to identify and quantify these variations in the functional status of patients with symptomatic BM to optimize the indication of surgical resection.

Patients and Methods Historic, retrospective cohort analysis of adult patients undergoing BM microsurgical resection, consecutively from January 2012 to May 2016, was conducted. The Karnofsky performance status (KPS) variation was recorded according to the symptomatic evolution of each patient at specific moments of the diagnostic–therapeutic algorithm. Finally, survival curves were delineated for the main identified factors.

Results One hundred and nineteen resection surgeries were performed. The median overall survival was 243 days, while on average it was 305.7 (95% confidence interval [CI]: 250.6–360.9) days. The indication of surgical resection of 10% of the symptomatic patients in our series (7.5% of overall) could have been initially rejected due to pharmacologically reversible neurologic impairment. Survival curves showed statistically significant differences when KPS was stratified following pharmacological symptomatic treatment (p < 0.0001), unlike when they were estimated at the time of BM diagnosis (p = 0.1128).

Conclusion The preoperative determination of the functional status by KPS as an evolutive parameter after the nononcologic symptomatic pharmacological treatment allowed us to optimize the surgical indication of patients with symptomatic BM.

Keywords

brain metastases - KPS - prognosis - steroids - surgical resection

Note

A preliminary summary of these data was previously presented at the “XIV Argentinian Conference of Neurosurgery,” Argentinian Association of Neurosurgery, Buenos Aires, Argentina, 2017.




Publication History

Received: 23 June 2019

Accepted: 30 December 2019

Article published online:
24 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Tabouret E, Chinot O, Metellus P, Tallet A, Viens P, Gonçalves A. Recent trends in epidemiology of brain metastases: an overview. Anticancer Res 2012; 32 (11) 4655-4662
    PubMedSearch in Google Scholar
  • 2 Kalkanis SN, Kondziolka D, Gaspar LE. et al. The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2010; 96 (01) 33-43
    CrossrefPubMedSearch in Google Scholar
  • 3 Al-Shamy G, Sawaya R. Management of brain metastases: the indispensable role of surgery. J Neurooncol 2009; 92 (03) 275-282
    CrossrefPubMedSearch in Google Scholar
  • 4 Onesti CE, Iacono D, Angelini S. et al. Unexpected long survival of brain oligometastatic non-small cell lung cancer (NSCLC) treated with multimodal treatment: a single-center experience and review of the literature. Transl Lung Cancer Res 2016; 5 (06) 712-719
    CrossrefPubMedSearch in Google Scholar
  • 5 Ekici K, Temelli O, Dikilitas M, Halil Dursun I, Bozdag Kaplan N, Kekilli E. Survival and prognostic factors in patients with brain metastasis: single center experience. J BUON 2016; 21 (04) 958-963
    Search in Google Scholar
  • 6 Andleeb A, Teli M, Lone M, Afroz F, Ahmad H, Fatima K. Brain metastases: a single institute experience. Clin Cancer Investig J 2016; 5 (03) 213-217
    CrossrefPubMedSearch in Google Scholar
  • 7 Lin X, DeAngelis LM. Treatment of brain metastases. J Clin Oncol 2015; 33 (30) 3475-3484
    CrossrefPubMedSearch in Google Scholar
  • 8 Gaspar L, Scott C, Rotman M. et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997; 37 (04) 745-751
    CrossrefPubMedSearch in Google Scholar
  • 9 Lagerwaard FJ, Levendag PC, Nowak PJCM, Eijkenboom WMH, Hanssens PEJ, Schmitz PIM. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys 1999; 43 (04) 795-803
    CrossrefPubMedSearch in Google Scholar
  • 10 Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 2008; 70 (02) 510-514
    CrossrefPubMedSearch in Google Scholar
  • 11 Weltman E, Salvajoli JV, Brandt RA. et al. Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 2000; 46 (05) 1155-1161
    CrossrefPubMedSearch in Google Scholar
  • 12 Lorenzoni J, Devriendt D, Massager N. et al. Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems. Int J Radiat Oncol Biol Phys 2004; 60 (01) 218-224
    CrossrefPubMedSearch in Google Scholar
  • 13 Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer 1948; 1 (04) 634-656
    CrossrefPubMedSearch in Google Scholar
  • 14 Kerschbaumer J, Bauer M, Popovscaia M, Grams AE, Thomé C, Freyschlag CF. Correlation of tumor and peritumoral edema volumes with survival in patients with cerebral metastases. Anticancer Res 2017; 37 (02) 871-875
    CrossrefPubMedSearch in Google Scholar
  • 15 Kesari S, Paleologos NA, Vick NA. Corticosteroids in neuro-oncology. In: Schiff D, Kesari S, Wen PY. eds. Cancer Neurology in Clinical Practice. Totowa, NJ: Humana Press; 2008: 47-56
    CrossrefSearch in Google Scholar
  • 16 Péus D, Newcomb N, Hofer S. Appraisal of the Karnofsky performance status and proposal of a simple algorithmic system for its evaluation. BMC Med Inform Decis Mak 2013; 13 (01) 72
    CrossrefPubMedSearch in Google Scholar
  • 17 Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 1984; 2 (03) 187-193
    CrossrefPubMedSearch in Google Scholar
  • 18 Ewend MG, Elbabaa S, Carey LA. Current treatment paradigms for the management of patients with brain metastases. Neurosurgery 2005; 57 (5, Suppl):, S1–S4 S66-S77
    CrossrefPubMedSearch in Google Scholar
  • 19 Lin J, Jandial R, Nesbit A, Badie B, Chen M. Current and emerging treatments for brain metastases. Oncology (Williston Park) 2015; 29 (04) 250-257
    PubMedSearch in Google Scholar
  • 20 Vecht CJ, Hovestadt A, Verbiest HB, van Vliet JJ, van Putten WL. Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day. Neurology 1994; 44 (04) 675-680
    CrossrefPubMedSearch in Google Scholar
  • 21 Maschio M, Dinapoli L, Sperati F. et al. Levetiracetam monotherapy in patients with brain tumor-related epilepsy: seizure control, safety, and quality of life. J Neurooncol 2011; 104 (01) 205-214
    CrossrefPubMedSearch in Google Scholar
  • 22 Saria MG, Nyamathi A, Phillips LR. et al. The hidden morbidity of cancer: burden in caregivers of patients with brain metastases. Nurs Clin North Am 2017; 52 (01) 159-178
    CrossrefPubMedSearch in Google Scholar
  • 23 Gates M, Alsaidi M, Kalkanis S. Surgical treatment of solitary brain metastases. Prog Neurol Surg 2012; 25: 74-81
    CrossrefPubMedSearch in Google Scholar
  • 24 Bindal RK, Sawaya R, Leavens ME, Lee JJ. Surgical treatment of multiple brain metastases. J Neurosurg 1993; 79 (02) 210-216
    CrossrefPubMedSearch in Google Scholar
  • 25 Mulvenna P, Nankivell M, Barton R. et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet 2016; 388 (10055): 2004-2014
    CrossrefPubMedSearch in Google Scholar
  • 26 Sperduto PW, Kased N, Roberge D. et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 2012; 30 (04) 419-425
    CrossrefPubMedSearch in Google Scholar