title: Influence on morbidity and mortality of neoadjuvant radiation and chemotherapy among cranial malignancy patients in the postoperative setting.
abstract: We sought to assess the impact of neoadjuvant therapy on 30 day mortality and morbidity using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Chemotherapy and radiotherapy are both often indicated for treatment of cranial or systemic malignancy but can have significant adverse effects in the postsurgical setting. Data from 2006 to 2012 were obtained from the national ACS-NSQIP database. A total of 1044 patients were identified who obtained surgery for removal of metastatic brain tumors, of whom 127 received neoadjuvant chemotherapy and 65 neoadjuvant radiotherapy. Our primary outcome was 30 day mortality and secondary outcomes were 30 day surgical and medical morbidities. We selected previously reported preoperative variables to build a univariate and a multivariate model to determine preoperative characteristics most associated with neurosurgical mortality and morbidity. Our study found that neoadjuvant chemotherapy was associated with a 2.4-fold increase in the risk of 30 day mortality compared to the patient cohort who did not receive chemotherapy (p=0.023). Interestingly, there was no statistically significant increase in overall 30 day surgical or medical morbidity for the chemotherapy group. Neoadjuvant radiotherapy was not associated with an increase in 30 day morbidity or mortality. The significant increase in mortality associated with chemotherapy warrants further investigation, particularly to determine how to best personalize neoadjuvant chemotherapy treatment options to improve surgical outcomes. Neoadjuvant radiotherapy may be safer in terms of short-term postoperative morbidity and mortality.
authors.affiliation: Department of Neurosurgery, New York University, New York, NY, USA.
authors.forename: Paul Narayan
authors.initials: PN
authors.lastname: Hein
authors.affiliation: Department of Neurosurgery, New York University, New York, NY, USA; Cerebrovascular Research Laboratory, Columbia University, New York, NY, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Lieber
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, Physicians and Surgeons Building Room 5-454, 630 West 168th Street, New York, NY 10032, USA; Cerebrovascular Research Laboratory, Columbia University, New York, NY, USA.
authors.forename: Eliza
authors.initials: E
authors.lastname: Bruce
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, Physicians and Surgeons Building Room 5-454, 630 West 168th Street, New York, NY 10032, USA; Cerebrovascular Research Laboratory, Columbia University, New York, NY, USA; College of Physicians and Surgeons, Columbia University, New York, NY, USA. Electronic address: bet2110@cumc.columbia.edu.
authors.forename: Blake
authors.initials: B
authors.lastname: Taylor
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, Physicians and Surgeons Building Room 5-454, 630 West 168th Street, New York, NY 10032, USA; Cerebrovascular Research Laboratory, Columbia University, New York, NY, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Appelboom
authors.affiliation: Cerebrovascular Research Laboratory, Columbia University, New York, NY, USA.
authors.forename: Mickey
authors.initials: M
authors.lastname: Abraham
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, Physicians and Surgeons Building Room 5-454, 630 West 168th Street, New York, NY 10032, USA; Cerebrovascular Research Laboratory, Columbia University, New York, NY, USA; Neuro-Intensive Care Unit, Columbia University Medical Center, New York, NY, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*
keywords: 30day outcomes; Chemotherapy; Malignancy; National Surgical Quality Improvement Program; Neoadjuvant; Radiation