Divu un vairāku cerebrālu metastāžu kompleksas ārstēšanas iespējas

The title of the doctoral thesis is Combined Therapy Options of One or More Cerebral Metastases . The doctoral theses is devoted to one of the most topical problems in the field of modern neurosurgery and oncology – treatment tactics in case of cerebral cancer metastases and possibilities to improve treatment outcomes using most recent available resources. Cerebral metastases are the most common type of intracranial tumors. As a result of improved extracranial pathology therapy outcomes and increased availability of neuroradiology examinations, the number of diagnosed cerebral metastases is tended to be increased. Now, also in Latvia, it is possible to use most recent therapeutic methods for the treatment of cerebral metastases: surgical resection, stereotactic radiosurgery, whole brain radiotherapy (WBRT) and chemotherapy. For patients with one cerebral metastasis, treatment tactics are usually standardized and is radical as possible including surgery and administration of complex therapy. In patients with two or more cerebral metastases clear indications for surgical and complex therapy cannot yet be found. The aim of our study was to analyse and compare possibilities and results of surgical and combined treatment in cases with two or more cerebral metastases and to evaluate first results of radiosurgical cerebral metastases treatment in Latvia. In the retrospective study were analysed data of 40 surgically-treated patients (including 14 patients receiving complex treatment in postoperative period) and first 16 patients in Latvia who received stereotactic radiosurgery therapy and radiotherapy; patients were treated at clinical centres of Riga East Clinical University Hospital during the time period from year 2005 to 2012. The therapy outcomes and survival in relation to clinical and radiological criteria and applied tactics for the treatment were evaluated, as well as analysis of genetic material of the evacuated cerebral metastases for determination of clinically significant mutation of gene TP53. A specialized software – IBM SPSS v.21– was used for data processing. As derived at the conclusion of the work the surgical evacuation of two or more cerebral metastases during a specified interval of time following the surgery allows to increase survival time and to maintain patient’s functional status. The best results of the surgical treatment of two or more cerebral metastases were obtained in the group of patients with 2–3 metastases after radical and total evacuation of all diagnosed cancer cerebral metastases. A statistically significant influence to a better prognosis of post-operative survival time show the following factors: number of metastases, radical evacuation of metastases, pre-operative KPS and RPA class indicators. Prognosis of survival in patients with oligometastases (median survival – 5.5 months) is 2.66 times longer than in patients with multiple cerebral metastases (median survival is 2.06 months) (p < 0.05). Administration of complex therapy (WBRT or WBRT and chemotherapy) in case of partial evacuation of cerebral metastases ensures a slightly prolonged survival time in comparison with cases of only partial surgical evacuation of metastases. Assessment of first 16 patients with small cerebral metastases (in diameter up to 3 cm) treated with radiosurgery in Latvia produce positive results requiring further research and analysis. Under genetic analysis of histological material (11 observations out of 40) there were established clinically significant mutations of gene TP53. No statistically significant influence between the post-operative survival ratio and mutations of gene TP53 was established during the study. As a result of the work there were developed practical recommendations on the choice of treatment tactics for patients with two or more cerebral metastases.