P08.24PREDICTIVE FACTORS OF PERITUMORAL EDEMA IN BRAIN METASTASES

摘要

OBJECT: To investigate peritumoral edema and its prognostic factors in brain metastases of lung and breast cancers, and more specifically to evaluate the effect of treatment with angiotensine-II (Ang2) inhibitors. This treatment was shown in a recent study to display a significant effect in primary brain tumor edema. MATERIALS AND METHODS: We retrospectively reviewed the medical files of all patients with newly diagnosed brain metastases consulting in our institution in the years 2012 and 2013. We measured the maximal diameter of lesions DL (contrast enhancement) and peritumoral edema DE (diameter of edema minus contrast enhancement) on the first diagnostic imaging of brain metastasis. Patients under steroids or files with insufficient informations were excluded from analysis. RESULTS: A total of 157 medical files were reviewed from which 54 patients with 170 metastases were selected for analysis. There were 87 metastases of lung adenocarcinomas, 35 of small cell carcinomas, 18 of epidermoiïd lung cancer, 7 of undifferentiated and 23 of breast cancer. Median DL was 9.35mm (1-74.3), median DE was 5,98mm (0-69,5). There was no significant difference in DL or DE between the histology groups. Younger age (<65 years old), female gender and treatment with Ang2 inhibitors seem to be associated with statistically less peritumoral edema (p = 0,005; p = 0,022; p = 0,005, respectively). This finding was persistent even when the 23 metastases of breast cancer were taken out from the analysis. Both DL and DE were smaller in the 25 patients under treatment with Ang2 inhibitors (n = 84 metastases) than in the 29 patients without such treatment (n = 86 metastases) (mean DL: 10.2 vs 13.4 mm, p= 0.036; mean DE 9.5 vs 15.9 mm, p= 0.005, respectively) The delay between the diagnosis of the primary tumors and brain metastases did not have any impact on the peritumoral edema. Moreover, the diameter of edema did not seem to be associated with the location, the size or the number of lesions, neither with the pattern of contrast enhancement (annular, homogenic or necrotic). Different patterns of contrast enhancement and sizes of edema were observed even within the same patient with multiple metastases. From the main 157 files reviewed, multiple metastases were more frequent in breast cancer patients (9 patients out of 10) compared to lung adenocarcinomas (29/81) and other lung cancers (13/25). CONCLUSION: In this series of patients with lung and breast cancer, younger age (<65 years old), female gender and treatment with Ang2 inhibitors seem to be associated with statistically smaller brain metastases and peritumoral edema Peritumoral edema did not seem to be associated with any other factors like histology, delayed brain metastasis diagnosis, size, location, number of lesions or contrast enhancing pattern.