Mmod-15 Surgical Resection and Stereotactic Radiosurgery in Combination for Local Therapy of Brain Metastases

OBJECTIVES Complex local treatment of BM combining surgical resection and radiosurgery provides the possibility of adequate local control while maintaining a satisfactory quality of life. METHODS Patients after surgical resection and postoperative radiotherapy treated between 2007-2023 were evaluated. Local control was assessed separately at the site of the operated MM (localPFS) and separately in other parts of the brain (distalPFS). RESULTS A total of 158 patients were enrolled (70 with WBRT), 56% were women, the median age was 61 years, the median performance status Karnofsky 78%. The most common primary tumor was lung carcinoma (39/118, 33%). Targeted stereotactic radiotherapy was significantly more often indicated in operations performed after 2016 (p <0.001). In the period 2013-2019, gross total resection was achieved significantly more often (88 vs 64%; p = 0.061). The median follow-up is 51 months. The median overall survival (OS) is 9,5 months (6.2 - 12), the median localPFS 24 months (14 - unattainable), median distPFS 12 months (6.8 - 27 months), median extracranialPFS 13 months (5.9 - 15). Stratification of patients according to the prognostic index brainmetgpa.com led to significant separation of patients for OS (p = 0.00017). In a multivariate analysis, stereotactic radiotherapy was statistically significant positive prognostic factor for OS compared to WBRT (median OS 18 vs. 6,1 months, HR 0.59, p = 0.018) with no effect on localPFS. CONCLUSION Our results of comprehensive local treatment of BM are comparable with the results presented by important foreign studies from prestigious oncology centers. We described targeted stereotactic postoperative radiotherapy as an independent positive prognostic factor after brain metastasectomy. The study was supported by Ministry of Health, Czech Republic-conceptual development of research organization (FNBr, 65269705).