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Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.109
vdae090.109
Final Category: Research Methods and Trial Design Considerations
AcademicSubjects/MED00300
AcademicSubjects/MED00310
RMTD-02 PRACTICE VARIATION AND IMPACT OF PRE-OPERATIVE AND POST-OPERATIVE DEXAMETHASONE ON PATIENT OUTCOME IN THE RESECTED BRAIN METASTASIS – INSIGHTS FROM THE CLINDEXMET MULTICENTER REGISTRY
Wasilewski David Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany
German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Berlin, Germany

Tommaso Araceli Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany

Rafaelian Artem Department of Neurosurgery, University Medicine Rostock, Rostock, Germany

Demetz Matthias Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

Asey Benedikt Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Ersoy Tunc-Faik Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld, Germany

Dauth Alice Department of Neurosurgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany

Peukert Ricarda Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany

Poeser Paul Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany

Jelgersma Claudius Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany

Früh Anton Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany

Xu Ran Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany

Capper David Institute of Neuropathology - Charite Universitätsmedizin Berlin, Berlin, Germany
German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Berlin, Germany

Ehret Felix Department of Radiooncology - Charite Universitätsmedizin Berlin, Berlin, Germany
German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Berlin, Germany

Frost Nikolaj Department of Infectious Diseases and Pulmonary Medicine - Charite Universitätsmedizin Berlin, Berlin, Germany

Schmidt Leon Department of Neurosurgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany

Krenzlin Harald Department of Neurosurgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany

Ringel Florian Department of Neurosurgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany

Meyer Hanno Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Gempt Jens Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Kerschbaumer Johannes Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

Freyschlag Christian Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

Thomé Claudius Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

Simon Matthias Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld, Germany

Dubinski Daniel Department of Neurosurgery, University Medicine Rostock, Rostock, Germany

Freiman Thomas Department of Neurosurgery, University Medicine Rostock, Rostock, Germany

Schmidt Nils Ole Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany

Proescholdt Martin Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany

Vajkoczy Peter Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany

Onken Julia Department of Neurosurgery - Charite Universitätsmedizin Berlin, Berlin, Germany
German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Berlin, Germany

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i33i33
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

BACKGROUND

Patients with brain metastases that undergo brain metastasis resection regularly receive perioperative dexamethasone. We sought to evaluate variation in pre- and post-operative dexamethasone dosing and whether perioperative dexamethasone in brain metastases is linked to patient outcome.

METHODS

This was a multicenter retrospective study collecting data on daily pre- and post-operative dexamethasone dosage over a period of 27 days in patients undergoing brain metastasis resection. Non arbitrary cutpoint selection was performed using maximally selected rank statistics to dichotomize patients. Propensity score matching served to reduce bias and adjust for potential confounders including tumor and edema volume, localization of the dominant brain metastasis, disease-specifc GPA score, presence of other non-oncological diseases.

RESULTS

988 patients were included. Median follow-up time was 55,2 months [95% CI: 50.7 – 61.5]. After propensity score matching patients below the determined cutpoint of 122 mg cumulative dexamethasone showed an overall survival of 16.0 months [95% CI: 13.3 – 21] vs. patients with more than 122 mg cumulative dexamethasone with a OS of 10.6 months [9.0 – 12.7], p=0.0022. No effect on extracranial or intracranial disease progression was observed. In a multivariable model for the matched data the cumulative peri-operative dexamethasone above the cutpoint remained independently associated with overall survival (HR: 1.3 [95% CI: 1.12 – 1.6], p=0.001).

CONCLUSION

Cumulative perioperative dexamethasone is associated with decreased survival in the context of brain metastasis resection. Strict dosage, down taper or methods reducing corticosteroid dependency should be regularly evaluated in clinical practice in patients with brain metastases.
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