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Stratification of Post-Operation Complication Rates of Patients with Metastatic Disease to the Brian Against Their Frailty Score

Friday, May 3, 2024

    Presenting Author(s)

  • CO

    Chinelo Onyiah, MS (she/her/hers)

    Medical Student
    Drexel University College of Medicine

    • Co-Author(s)

  • SK

    Stephen Karlovits, MD

    Physician, Radiation Oncology
    Allegheny Health Network Cancer Institute
    Pittsburgh, Pennsylvania, United States

  • JL

    Jenna Li, MS

    Statistician
    Allegheny Health Network Neuroscience Institute, United States

  • YL

    Yun Liang, PhD

    Medical Physicist, Radiation Oncology
    Allegheny Health Network Cancer Institute, United States

  • Sanjay Rajkumar, n/a

    Medical Student
    Drexel University College of Medicine
    Philadelphia, PA, US

  • Matthew J. Shepard, MD

    Director of Brain Tumor Research
    Allegheny Health Network
    Pittsburgh, Pennsylvania, United States

  • RW

    Rodney E. Wegner, MD

    Physician, Radiation Oncology
    Allegheny Health Network, United States

  • AY

    Alexander Yu, MD

    Vice Chair, Department of Neurosurgery
    Allegheny Health Network
    Pittsburgh, Pennsylvania, United States

Introduction: Patients with large and/or symptomatic brain metastases (BM) often require surgical excision followed by adjuvant stereotactic radiosurgery (SRS). We recently demonstrated that increasing frailty is associated with diminished OS/PFS following SRS for BMs. The impact of frailty on peri-operative morbidity following the surgical excision of BMs has not been fully investigated.

Methods: A retrospective cohort study was performed on patients with BMs who underwent craniotomy for BM resection. The 5-factor modified frailty index (mFI-5) was utilized to classify patients into pre-frail (mFI-5: 0-1) and frail (mFI-5: 2+). Primary outcomes included overall survival (OS) as well as 30/90 day neurologic and medical complications. Secondary outcomes included length of stay.

Results: 62 patients who underwent surgery prior to receiving SRS to one or more BMs with at least 30 days of clinical/radiographic follow-up were included. NSCLC was the most common primary tumor resected (36%). Patients were predominantly classified as pre-frail compared to frail (prefrail: n= 36, 59%; frail: n=20, 33%). Average metastatic tumor size was the same for both cohorts (3.6 cm). Frail status was associated with diminished OS following surgery (p=0.003) than in pre-frail cohort. The median OS was 24 months for pre-frail and 11.7 months for frail. Post-operative neurologic complication rates were similar between the frail and pre-frail cohorts for 30/90 days. Frail status was associated with increased rates of post-operative pneumonia (30 days: 0% for prefrail vs 4% for frail patients; 90 days: 2.7% for pre-frail vs 12% for frail). Post-operative LOS was similar amongst both cohorts (mean 4-days in both cohorts).

Conclusion : Increased levels of frailty as measured by the predictive model mFI-5 appear to correlate with decreased OS status post-surgery. Medical complication rates are more common in the frail cohort.