Artikel
Do size or multiplicity of cerebral metastases predict Infiltration into brain parenchyma?
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Cerebral metastases are known to exhibit infiltrative behavior beyond macroscopic tumor boundaries. We hypothesized that the size of a cerebral metastasis and the presence of multiple filiae are predictors of cellular invasion beyond the conventional limits of a tumor as determined by macroscopic appearance. This could have implications on the surgical treatment of larger metastases which might warrant more aggressive – i.e. supratotal – resection strategies.
Methods: Patients with suspected cerebral metastases were enrolled in a prospective protocol and underwent resection of a cerebral lesion. Based on the Metastasys-trial protocol, biopsies were obtained at the margins of resection and analyzed for histological evidence of tumor cells. The size and number of cerebral lesions were correlated with the dichotomized invasion pattern using Chi2-tests with a 2-sided significance level of p<0.05. Statistical workup was performed using SPSS 18.0 (IBM).
Results: Sixty-one patients were operated with a mean age of 63+-8 years. 26/61 patients (43%) had evidence of more than one metastasis. Average tumor size was 31+-13mm. Infiltration was found in 49/61 (80%) with similar degrees across primary tumor type. In cases with infiltration, multiple cerebral metastases were present in 21/49 cases (43%). In cases without infiltration, the rate of multiple lesions was similar (5/12; 42%, p=0.94). In 27 patients, tumor size exceeded 30mm (47%) while 31 had smaller tumors (53%). Histological evidence of tumor infiltration was found in 25/31 in smaller lesions (81%) and 22/27 in larger lesions (82%, p=0.94).
Conclusion: Based on our prospective series, we could not confirm the hypothesis that infiltration of a metastatic tumor is associated with tumor size. Our data do not warrant altering the surgical strategy towards more aggressive transmarginal resection in larger lesions.