Kemal ERTİLAV, Serdar ERCAN, Zeki Serdar ATAİZİ

Metastatik Beyin Tümörü Tedavisinde Sağkalımı Etkileyen Faktörler

Amaç: Kanserlerin sistemik tedavilerindeki gelişmeler ve manyetik rezonans (MR) görüntülemesinin yaygınlaşması nedenleri ile beyin metastazlarının görülme sıklığı her gün artmaktadır. Ancak bu artışa paralel olarak giden temel tedavi yöntemleri bulunmamaktadır. Bu çalışmada cerrahi girişimin sağkalıma olan etkileri incelendi. Materyal-Metot: 2014 -2017 yılları arasında metastatik beyin tümörü tanısı ile hastanemize başvuran ve cerrahi müdahale yapılan hastalar çalışmaya dahil edildi. Demografik bilgiler retrospektif olarak hasta kayıtlarından derlendi ve bu hastalar düzenli aralıklar ile takip edildi. Elde edilen veriler SPSS kullanılarak long rank ve Cox’un oransal modeli kullanılarak çok değişkenli olarak analiz edildi ve p70 bulundu. Performans skoru yüksek olan hastalarda daha uzun sağkalım olduğu anlaşıldı. Toplam sağkalım KPS>70 olan hastalarda ortalama 7 ay ve KPS

Factors Affecting Survival in Metastatic Tumor Treatment

Objective: The incidence of brain metastases increases everyday due to the advances in systemic treatment of cancersand the widespread of magnetic resonance imaging (MR)scanning. However, there are no basic treatment methods thatgo parallel to this increase. In this study, the effects of surgicalintervention on survival were examined.Material-Method: Patients who were admitted to our hospitalwith a diagnosis of metastatic brain tumor between 2014 and2017 and who underwent surgery were included in the study.Demographic information was compiled retrospectively frompatient records and these patients were followed at regularintervals. The data obtained were analyzed as multivariateusing the proportional model of Cox and long rank test usingSPSS, and p 70 was found in 75% of patients. Longersurvival was observed in patients with high performancescores. Total survival was 7 months in patients with KPS>70,and 2 months in patients with KPS

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1. Lowery FJ, Yu D. Brain metastasis: unique challenges and open opportunities. Biochim Biophys Acta (BBA)-Reviews Cancer. 2017;1867(1):49–57.
2. Brastianos PK, Carter SL, Santagata S, Cahill DP, Taylor- Weiner A, Jones RT, et al. Genomic characterization of brain metastases reveals branched evolution and potential therapeutic targets. Cancer Discov. 2015;5(11):1164–77.
3. Lah TT, Novak M, Breznik B. Brain Malignancies: Cancer Cell Trafficking in and out of the Niches. Semin Cancer Biol [Internet]. 2019; Available from: http://www.ncbi.nlm.nih. gov/pubmed/31654711
4. Achrol AS, Rennert RC, Anders C, Soffietti R, Ahluwalia MS, Nayak L, et al. Brain metastases. Nat Rev Dis Prim. 2019;5(1):1–26.
5. Owonikoko TK, Arbiser J, Zelnak A, Shu HKG, Shim H, Robin AM, et al. Current approaches to the treatment of metastatic brain tumours. Vol. 11, Nature Reviews Clinical Oncology. 2014. p. 203–22.
6. Salehi A, Kamath AA, Leuthardt EC, Kim AH. Management of intracranial metastatic disease with laser interstitial thermal therapy. Front Oncol. 2018;8(OCT):1–6.
7. Distefano A, Yap HY, Hortobagyi GN, Blumenschein GR. The natural history of breast cancer patients with brain metastases. Cancer. 1979;44(5):1913–8.
8. Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005;75(1):5–14.
9. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):48–54.
10. Schellinger PD, Meinck HM, Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J Neurooncol. 1999;44(3):275–81.
11. Sze G, Milano E, Johnson C, Heier L. Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT. Am J Neuroradiol. 1990;11(4):785–91.
12. Davis FG, Dolecek TA, McCarthy BJ, Villano JL. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol. 2012;14(9):1171–7.
13. Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain metastases: histology, multiplicity, surgery, and survival. Cancer Interdiscip Int J Am Cancer Soc. 1996;78(8):1781–8.
14. Zhang X, Zhang W, Cao W-D, Cheng G, Liu B, Cheng J. A review of current management of brain metastases. Ann Surg Oncol. 2012;19(3):1043–50.
15. Sunderland GJ, Jenkinson MD, Zakaria R. Surgical management of posterior fossa metastases. J Neurooncol [Internet]. 2016;130(3):535–42. Available from: http://dx.doi. org/10.1007/s11060-016-2254-2
16. Kalkanis SN, Kondziolka D, Gaspar LE, Burri SH, Asher AL, Cobbs CS, 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(1):33–43.
17. Vecht CJ, Haaxma‐Reiche H, Noordijk EM, Padberg GW, Voormolen JHC, Hoekstra FH, et al. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery. Ann Neurol Off J Am Neurol Assoc Child Neurol Soc. 1993;33(6):583–90.
18. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al. Stereotactic radiosurgery plus wholebrain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. Jama. 2006;295(21):2483–91.
19. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500.
20. Mekhail T, Sombeck M, Sollaccio R. Adjuvant wholebrain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. Curr Oncol Rep. 2011;13(4):255–8.
21. Thon N, Kreth F-W, Tonn J-C. The role of surgery for brain metastases from solid tumors. In: Handbook of clinical neurology. Elsevier; 2018. p. 113–21.
22. Lee C-H, Kim DG, Kim JW, Han JH, Kim YH, Park C-K, et al. The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study. Acta Neurochir (Wien). 2013;155(3):389–97.