neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"neurosurgery-5Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTВлияние клинических факторов на продолжительность жизни в послеоперационном периоде у больных с множественными метастазами злокачественных опухолей в головной мозгThe influence of clinical factors on postoperative life duration at patients with brain multiple metastases of malignant tumorsАусландсКаспарс ЯновичAuslandsK. Ya.ka75@inbox.lvКарклиняЮлия АлександровнаKarliniaJu. V.jkarklina@inbox.lvАпшкалнеДайна ЛюдвиговнаApshkalisD. L.daina.apskalne@inbox.lvОзолсРолф ЯновичOzolsR. Ya.ozols_5@inbox.lvРижская Восточная Клиническая Университетская больница, клиника «Гайлезерс»Russian FederationРижская Восточная Клиническая Университетская больница, клиники «Гайлезерс»Russian Federation201305102017013135Copyright © Аусландс К.Я., Карклиня Ю.А., Апшкалне Д.Л., Озолс Р.Я., 20172017Аусландс К.Я., Карклиня Ю.А., Апшкалне Д.Л., Озолс Р.Я.Auslands K.Y., Karlinia J.V., Apshkalis D.L., Ozols R.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/5

Цель исследования: провести анализ влияния клинических факторов на продолжительность жизни после операции у больных с множественными метастазами злокачественных опухолей в головной мозг. Материалы и методы: произведен ретроспективный анализ историй болезни пациентов, прооперированных по поводу множественных метастазов в головной мозг, в Рижской Восточной Клинической Университетской больнице «Гайлезерс» (2005-2010 гг.) При обработке данных использовались компьютерные программы SPSS (Statistical Package for the Social Sciences) и Med Calc. Результаты: в течение 6 лет 36 больным со множественными церебральными метастазами были произведены одна или более краниотомий. Послеоперационные показатели продолжительности составили от 16 дней до 37,5 мес (в среднем = 7,29 мес; 95% доверительный интервал (CJ) 4,60-9,98%). Если рассматривать пациентов по RPA классам, показатели продолжительности жизни в месяцах составляют: 11,75 - RPA I, 8,58 - RPA II и 5,31 - RPA III. Заключение: результаты исследования подчеркивают необходимость дальнейших проспективных исследований с целью оптимизации тактики лечения больных с множественными церебральными метастазами

Background and objective. Although surgery has traditionally been performed for patients with a single brain metastasis, an increasing number of patients with multiple brain metastases may also be treated surgically. The objective of the study was to analyse postoperative survival results and the clinical factors affecting them. Material and methods. The records of patients who underwent surgical resection of two or more lesions between January, 2005 and January, 2010 were retrospectively reviewed. Survival was calculated from the date of surgery to the last follow-up evaluation or death and different clinical factors were analyzed in regards to patient survival. Statistical analysis was performed using the SPSS and MedCalc for Windows software. Results. 36 patients underwent one or more craniotomies. Survival of entire group ranged from 16 days to 37,5 months (mean = 7,29 months). There were four death within 30 days. When divided into Radiation Therapy Group RPA classes, the survival rates were 11,75 , 8,58 and 5,31 month for Classes I, II and III, respectively. Regarding impact on survival statistically significant association with a favourable outcome was found for the following factors: number of brain metastases (2-3 vs. 4-6) p= 0,019 and radicality of metastases removal (all vs. partial) p= 0.018. Conclusions. Well-selected patients with multiple brain metastases appear to benefit from surgery.

множественные церебральные метастазыхирургическое лечениеmultiple brain metastasessurgeryReferencesAgboola O., Benoit B., Cross P. et al. Prognostic factors derived from recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases. Int J Radiat Oncol Biol Phys 1998; 42: 155-159.Agboola O., Benoit B., Cross P. et al. Prognostic factors derived from recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases. Int J Radiat Oncol Biol Phys 1998; 42: 155-159.Al-Shamy G., Sawaya R. Management of brain metastases: the indispensable role of surgery. J Neurooncol 2009; 92: 275-28.Al-Shamy G., Sawaya R. Management of brain metastases: the indispensable role of surgery. J Neurooncol 2009; 92: 275-28.Bindal R.K., Sawaya R., Leavens M.E. et al. Surgical treatment of multiple brain metastases. J Neurosurg 1993; 79: 210-216.Bindal R.K., Sawaya R., Leavens M.E. et al. Surgical treatment of multiple brain metastases. J Neurosurg 1993; 79: 210-216.Delattre J.Y., Krol G.,Thaler H.T. et al. Distribution of brain metastases. Arch.Neurol. 1988; 45: 741-744.Delattre J.Y., Krol G.,Thaler H.T. et al. Distribution of brain metastases. Arch.Neurol. 1988; 45: 741-744.Gaspar L.E., Scott C., Rotman M. et al. Recursive partitioning analysis ( RPA ) of prognostic factors in three three Radiation Therapy Oncology Group bramin metastases trials. Int J Radiat Oncol Biol Phys 1997; 37: 745-751.Gaspar L.E., Scott C., Rotman M. et al. Recursive partitioning analysis ( RPA ) of prognostic factors in three three Radiation Therapy Oncology Group bramin metastases trials. Int J Radiat Oncol Biol Phys 1997; 37: 745-751.Hazuka M.B., Burleson W.D., Stroud D.N. et al. Multiple brain metastases are associated with poor survival in patients treated with surgery and radiotherapy. J Clin Oncol 1993; 11: 369-373.Hazuka M.B., Burleson W.D., Stroud D.N. et al. Multiple brain metastases are associated with poor survival in patients treated with surgery and radiotherapy. J Clin Oncol 1993; 11: 369-373.Kocher M., Soffietti R., Abacioglu U. et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 2011; 29: 134-141.Kocher M., Soffietti R., Abacioglu U. et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 2011; 29: 134-141.Nieder C., Andratschke N., Grosu A.L. et al. Recursive partitioning analysis (RPA) class does not predict survival in patients with four or more brain metastases. Strahlenther Onkol 2003; 179: 16-20.Nieder C., Andratschke N., Grosu A.L. et al. Recursive partitioning analysis (RPA) class does not predict survival in patients with four or more brain metastases. Strahlenther Onkol 2003; 179: 16-20.Pollock B.E., Brown P.D., Foote R.L. et al. Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. J Neurooncol 2003; 61: 73-80.Pollock B.E., Brown P.D., Foote R.L. et al. Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. J Neurooncol 2003; 61: 73-80.Rades D., Pluemer A., Veninga T. et al. Whole-brain radiotherapy versus stereotactic radiosurgery for patients in recursive partitioning analysis classes 1 and 2 with 1 to 3 brain metastases. Cancer 2007; 110: 2285-2292.Rades D., Pluemer A., Veninga T. et al. Whole-brain radiotherapy versus stereotactic radiosurgery for patients in recursive partitioning analysis classes 1 and 2 with 1 to 3 brain metastases. Cancer 2007; 110: 2285-2292.Ransohoff J. Surgical management of metastatic tumors. // Semin Oncol. 1975; 2: 21-27.Ransohoff J. Surgical management of metastatic tumors. // Semin Oncol. 1975; 2: 21-27.Sawaya R., Bindal R.K. Metastatic brain tumors. Brain Tumors. Edinburgh: Churchill Livingstone, 1995: 923-946.Sawaya R., Bindal R.K. Metastatic brain tumors. Brain Tumors. Edinburgh: Churchill Livingstone, 1995: 923-946.Soffirtti R., Cornu P., Delattre J.Y. et al. EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 2006; 13: 674-81.Soffirtti R., Cornu P., Delattre J.Y. et al. EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 2006; 13: 674-81.Tsao M.N., Lloyd N.S., Wong R.K. et al. Radiotherapeutic management of brain metastases: A systematic review and metaanalysis. Cancer Treat Rev 2005; 31: 256-273.Tsao M.N., Lloyd N.S., Wong R.K. et al. Radiotherapeutic management of brain metastases: A systematic review and metaanalysis. Cancer Treat Rev 2005; 31: 256-273.

The authors declare that there are no conflicts of interest present.