KEY TAKEAWAYS
- The study aimed to assess hemorrhage risk in BM from various cancers and the safety of surgical removal.
- The study found anticoagulation and neurosurgery safe for patients with BM, but intra-tumoral hemorrhage worsens survival. More research is needed.
Intracerebral metastases from brain cancer pose a significant risk of tumor-associated intracerebral hemorrhage (ICH).
Laurèl Rauschenbach and the team aimed to assess the hemorrhage risk in brain metastases (BM) from different primary tumor sites and evaluate the safety and outcomes of surgical tumor removal.
Researchers conducted a retrospective, single-center review of medical records for patients who underwent BM removal between January 2016 and December 2017. They compared patients with hemorrhagic BM to those with non-hemorrhagic BM, collecting and analyzing data on preoperative predictors, perioperative management, and postoperative outcomes.
The results revealed that 229 individuals met the inclusion criteria. Melanoma metastases were significantly associated with preoperative hemorrhage, even after adjusting for confounding factors (P= 0.001). Poor clinical status (P= 0.001), larger tumor volume (P= 0.020), and unfavorable prognosis (P= 0.001) independently predicted spontaneous hemorrhage. Importantly, preoperative anticoagulant use was not linked to increased hemorrhagic risk (P= 0.592).
Surgical removal of hemorrhagic BM after pausing blood-thinning medications did not significantly impact intraoperative blood loss, surgical duration, or postoperative rebleeding risk (P> 0.096). However, intra-tumoral hemorrhage was associated with reduced overall survival (P= 0.001).
The study underscored the safety of anticoagulation in patients with BM and the safety of neurosurgical treatment in those with hemorrhagic BM when blood-thinning medication is temporarily paused. Intra-tumoral hemorrhage negatively impacts survival, highlighting its prognostic significance for people with BM. Further research with larger cohorts is needed to validate these findings and elucidate the underlying mechanisms.
No funding was received.
Source: https://link.springer.com/article/10.1007/s11060-024-04714-2
Rauschenbach, L., Kolbe, P., Engel, A., et al. (2024). “Predictors and surgical outcome of hemorrhagic metastatic brain malignancies.” J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04714-2
