COST AND SURVIVAL ANALYSIS OF METASTATIC CEREBRAL-TUMORS TREATED BY RESECTION AND RADIATION

THE SURGICAL TREATMENT of metastatic brain tumors remains controversia l, primarily because of the limited prognosis of patients with metasta tic cancer. The cost effectiveness of even standard therapies is of in creasing concern to third-party payers. We reviewed the records of pat ients who had a single metastatic brain tumor resected at the Medical Center Hospital of Vermont (a referral center in a rural state) since cost data recording began. The 32 patients ranged in age from 35 to 77 years, with a 2.2:1 female-to-male ratio. Thirty-four percent of tumo rs originated in the lung, 15.6% were renal, 12.5% were breast, 12.5% were gynecological, 9.4% were gastrointestinal, and 9.4% were ultimate ly of unknown origin. Thirty-one tumors were completely resected; 30 p atients were irradiated, most after surgery (mean dose, 3,908 +/- 1,25 0 cGy). Karnofsky scores improved from 80 +/- 11 to 88 +/- 16 postoper atively (P = 0.0038, one-tailed paired t-test). Patients were hospital ized an average of 8.22 +/- 6.26 days postoperatively, with total oper ative and postoperative charges of $19,190 +/- 5,684, noninclusive of radiotherapy. The expected median survival of all patients was 26 mont hs (Kaplan-Meier estimate). The presence of disseminated disease was n ot significantly correlated with survival (P = 0.237). The number of p ostoperative days was more for patients with disseminated disease (P = 0.0274), but not for patients with infratentorial tumors (P = 0.6991) . Age higher than the median was not correlated with an increased numb er of postoperative days (P = 0.1366) nor was a preoperative Karnofsky score of 70 or less (P = 0.1382). We believe that the cost of adding surgical therapy is not out of proportion to the degree of palliation achieved, especially because surgical treatment can result in rapidly improved function and long-term survivals are not uncommon. Factors su spected to influence the length of hospitalization such as age and tum or location do not affect postoperative stay and thus the cost of trea tment.