Metastatik Beyin Tümörlü Olgularda Tümörün Özellikleri ve Tümör Cerrahisinin Sağkalım Üzerine Etkilerinin Retrospektif Olarak Analizi: Tek Merkezli Çalışma

Öz

Amaç: Metastatik beyin tümörleri; günümüzde insidansı sürekli artmakta olan ciddi morbidite ve mortaliteye neden olabilecek patolojiler arasındadır. Kliniğimizde opere olmuş metastatik beyin tümürlü olguların demografik özellikleri, lezyonun primer kaynaklandığı odağı, metastaz sayısı ve lokalizasyonunu retrospektif olarak inceleyerek morbidite ve mortalite üzerine etkisini tartışmayı amaçladık. Gereç ve Yöntemler: Bu çalışmada retrospektif olarak kliniğimizde 01.01.2022-31.12.2024 tarihleri arasında intrakranial kitle nedeni opere edilen ve metastatik beyin tümörü tanısı almış olguların demografik özellikleri, metastatik tümörünün ve kliniğinin verileri toplandı. Sonuçlar istatistiksel olarak analiz edildi. P<0.05 anlamlı kabul edildi. Bulgular: Çalışmada toplam 67 hasta yer almaktadır. Hastaların yaş ortalaması 63 ± 10 yıldır. Çalışma grubunda erkek hastalar (51 kişi, %76,12), kadın hastalara (16 kişi, %23,88) göre belirgin çoğunlukta idi. En sık görülen tümör yerleşimi pariyetal bölge (22 kişi, %32,83) olarak dikkat çekmektedir. Bunu 2. sıklıkta frontal lob tümörleri (15 kişi, %22,39) ve serebellar bölge tümörleri (15 kişi, %22,39) takip etmektedir. Hastaların büyük çoğunluğunda cerrahi endikasyonu olan tek bir metastaz (49 hasta, %73,13) bulunmaktadır. Beyin metastazlarının birincil kaynağı incelendiğinde, akciğer kanseri (37 hasta, %55,22) açık ara en yaygın neden olarak öne çıkmaktadır. Meme kanseri (%8,96) ve böbrek kanseri (%7,46) de diğer önemli primer kaynaklardır. Hastalara çoğu cerrahi olarak subtotal rezeksiyon (%62,69) yapılmıştır. Hastaların çoğunluğunda, preoperatif döneme göre ek bir morbidite veya nörolojik defisit gözlenmemiştir (59 kişi, %88,06). 14 hasta (%20,9) neoplazma kaynaklı exitus olurken, bunlardan 8 tanesi (%11,94) postoperatif dönemde exitus olmuştur. Sonuç: Metastatik beyin tümörlerinde, metastazın yerleştiği lokalizasyon, cerrahi olarak lezyonun total ya da subtotal çıkarılması tümör kaynaklı hastanın sağkalımı ve mortalitesinde önemli bir yer edinmektedir.

Anahtar Kelimeler

• Metastatik Beyin Tümörü
• Santral Sinir Sistemi Metastazları
• Sağkalım

Retrospective Analysis of Tumor Characteristics and Effects of Tumor Surgery on Survival in Metastatic Brain Tumor Cases: A Single Centre Study

Öz

Objective: Metastatic brain tumors are among the pathologies that can cause serious morbidity and mortality with an increasing incidence. We aimed to retrospectively examine the demographic characteristics, primary origin of the lesion, number and localization of metastases in patients with metastatic brain tumors operated in our clinic and to discuss their effects on morbidity and mortality. Materials and Methods: In this study, we retrospectively collected demographic characteristics, metastatic tumor and clinic data of patients who were operated for intracranial mass and diagnosed with metastatic brain tumor between 01.01.2022-31.12.2024 in our clinic. The results were analyzed statistically. P<0.05 was considered significant. Results: A total of 67 patients were included in the study. The mean age of the patients was 63 ± 10 years. In the study group, male patients (51 patients, 76.12%) were significantly more common than female patients (16 patients, 23.88%). The most common tumor location was the parietal region (22 patients, 32.83%). This was followed by frontal lobe tumors (15 patients, 22.39%) and cerebellar region tumors (15 patients, 22.39%). The majority of patients had a single metastasis (49 patients, 73.13%) for which surgery was indicated. When the primary source of brain metastases is analyzed, lung cancer (37 patients, 55.22%) is by far the most common cause. Breast cancer (8.96%) and kidney cancer (7.46%) were other important primary sources. Most patients were surgically treated with subtotal resection (62.69%). The majority of patients had no additional morbidity or neurologic deficit compared to the preoperative period (59 patients, 88.06%). While 14 patients (20.9%) had neoplasm-induced exitus, 8 of them (11.94%) had exitus in the postoperative period. Conclusion: In metastatic brain tumors, the localization of the metastasis and total or subtotal surgical removal of the lesion play an important role in the survival and mortality of the patient with tumor origin.

Anahtar Kelimeler

• Metastatic Brain Tumor
• Central Nervous System Metastases
• Survival

Kaynakça

1. 1. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):48–54.
2. 2. Wen PY, Loeffler JS. Management of brain metastases. Oncology (Williston Park). 1999;13(7):941–954, 957–961.
3. 3. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the metropolitan detroit cancer surveillance system. J Clin Oncol. 2004;22(14):2865–2872.
4. 4. Ostrom QT, Wright CH, Barrnholtz-Sloan JS. Brain metastases: epidemiology. Handb Clin Neurol. 2018;149:27–42.
5. 5. Rapp SR, Case LD, Peiffer A, Naughton MM, Chan MD, Stieber VW, et al. Donepezil for irradiated brain tumor survivors: a phase III randomized placebo-controlled clinical trial. J Clin Oncol. 2015;33(15):1653–1659.
6. 6. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037–1044.
7. 7. Brown PD, Gondi V, Pugh S, Tome WA, Wefel JS, Armstrong TS, et al. Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases: phase III trial NRG oncology CC001. J Clin Oncol. 2020;38(10):1019–1029.
8. 8. Zuo C, Liu G, Bai Y, Tian J, Chen H. The construction and validation of the model for predicting the incidence and prognosis of brain metastasis in lung cancer patients. Transl Cancer Res. 2021; 10:22–37.

9. 9. Hao Y, Li G. Risk and prognostic factors of brain metastasis in lung cancer patients: a surveillance, epidemiology, and end results population–based cohort study. Eur J Cancer Prev. 2023;32:498– 511.
10. 10. Johnson JD, Young B. Demographics of brain metastases. Clin N Am. 1996;7:337–344.
11. 11. Schroeder T, Bittrich P, Kuhne JF, Noebel C, Leischner H, Fiehler J, et al. Mapping distribution of brain metastases: does the primary tumor matter? J Neurooncol. 2020 Mar;147(1):229-235.
12. 12. Cagney DN, Martin AM, Catalano PJ, Brown PD, Alexander BM, Lin NU, Aizer AA. Implications of Screening for Brain Metastases in Patients With Breast Cancer and Non-Small Cell Lung Cancer. JAMA Oncol. 2018 Jul 1;4(7):1001-1003.
13. 13. Lamba N, Catalano PJ, Cagney DN, Haas-Kogan DA, Bubrick EJ, Wen PY, Aizer AA. Seizures Among Patients With Brain Metastases: A Population- and Institutional-Level Analysis. Neurology. 2021 Feb 22;96(8):e1237-e1250.
14. 14. Noh T, Walbert T. Chapter 6 - Brain metastasis: clinical manifestations, symptom management, and palliative care. In: Schiff D, van den Bent MJ, eds. Handbook of Clinical Neurology. Vol 149. Elsevier; 2018:75–88.
15. 15. Schellinger PD, Meinck HM, Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J Neurooncol. 1999; 44: 275-281.
16. 16. Sze G, Milano E, Johnson C, Heier L. Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT. AJNR Am J Neuroradiol. 1990; 11: 785-791.
17. 17. Nagai A, Shibamoto Y, Mori Y, Hashizume C, Hagiwara M, Kobayashi T. Increases in the number of brain metastases detected at frame-fixed, thin-slice MRI for gamma knife surgery planning. Neuro Oncol. 2010; 12: 1187-1192.
18. 18. Kamp MA, Rapp M, Bühner J, Slotty PJ, Reichelt D, Sadat H, et al. Early postoperative magnet resonance tomography after resection of cerebral metastases. Acta Neurochir (Wien) 2015;157:1573– 1580.
19. 19. Lee CH, Kim DG, Kim JW, Han JH, Kim YH, Park CK, et al. The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study. Acta Neurotic (Wien) 2013;155:389– 397.
20. 20. Olesrud IC, Schulz MK, Marcovic L, Kristensen BW, Pedersen CB, Kristiansen C, Poulsen FR. Early postoperative MRI after resection of brain metastases-complete tumour resection associated with prolonged survival. Acta Neurochir (Wien) 2019;161:555–565.
21. 21. Tendulkar RD, Liu SW, Barnett GH, Vogelbaum MA, Toms SA, Jin T, et al. RPA classification has prognostic significance for surgically resected single brain metastasis Int J Radiat Oncol Biol Phys 2006;66 810–817.
22. 22. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the metropolitan detroit cancer surveillance system. J Clin Oncol. 2004;22(14):2865-272.
23. 23. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77(3):655-661.
24. 24. Shaimaa Fadel, Asmaa Ellaithy. Brain metastasis: Incidence, trend analysis, and impact on survival using SEER database (2010- 2020). Journal of Clinical Oncology (2025) 43.16_suppl.2021