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Evaluación de la sobrevida de pacientes con metástasis cerebrales tratados con cirugía más radioterapia o con radioterapia sola

Survival rate evaluation of patients with brain metastasis treated with surgery plus radiotherapy or with radiotherapy alone

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Resumen

Fundamento. Está en discusión cuál es el tratamiento más adecuado en términos de sobrevida para los pacientes con metástasis cerebrales (MC) cuando son tratados con cirugía más radioterapia (Cir+RT) o con radioterapia (RT) sola.

Objetivos. Identificar grupos de distinto pronóstico de acuerdo a características clínicas y tratamiento, en términos de sobrevida global.

Pacientes y métodos. Diseño analítico con 88 pacientes en un seguimiento de 24 meses (34 tratados con Cir+RT y 54 con RT sola). Los criterios quirúrgicos fueron específicos para cada caso. Todos fueron tratados con similares dosis de RT.

Resultados. Los grupos fueron balanceados y similares, excepto por el 61,8% de MC únicas en el grupo Cir+RT y el 33,3% en RT sola (p=0,01). El análisis multivariado identificó al estatus neurofuncional y a la diseminación metastásica como variables pronósticas independientes. De la combinación surgieron tres grupos de pronóstico diferente.

Conclusiones. Con un óptimo estatus neurofuncional, cualquiera que fuera la extensión de MC, el grupo Cir+RT tuvo mayor sobrevida. En casos neurofuncionales agravados, con/sin diseminación sistémica, la RT sola pareció ser mejor tratamiento que el agregado de cirugía.

Abstract

Background. The most appropiated treatment in terms of the survival rate for patients with brain metastases (BM) between surgery plus radiotherapy (Surg+RT) or radiotherapy (RT) alone is matter of controversy.

Aims. To identify different prognostic groups according to clinical characteristics and treatment, in terms of global survival rate.

Patients and method. Eighty eigth patients were followed for 24 moths (34 treated with Surg+RT and 54 with RT alone) in analytical design. Surgical criteria were specific to in each case. Similar RT schedules were applied to all patients.

Results. Groups were balanced and similar, except for a 61.8% of solitary MC in Surg+RT group against 33.3% in RT alone group (p=0.01). Neurofunctional status and MC spread were identified as independent prognostic variables by multivariate analysis. From combining them, three groups of different survival rate updated.

Conclusion. With optimal neurofunctional status, any MC spread, Surg+RT group showed the best survival rate of three groups. In case of worse neurofunctional status, RT alone suggested better treatment than addition of neurosurgery.

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Authors and Affiliations

  1. Terapia Radiante Cumbres, Spain

    Susana Kahl, José Mc Donnell & Marta Alarcón Beretta

  2. Servicio de Neurocirugía del Sanatorio Parque, Rosario, Argentina

    José Nallino

Authors
  1. Susana Kahl
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  2. José Nallino
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  3. José Mc Donnell
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  4. Marta Alarcón Beretta
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Correspondence to Susana Kahl or Marta Alarcón Beretta.

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Kahl, S., Nallino, J., Mc Donnell, J. et al. Evaluación de la sobrevida de pacientes con metástasis cerebrales tratados con cirugía más radioterapia o con radioterapia sola. Rev Oncol 5, 218–222 (2003). https://doi.org/10.1007/BF02712405

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