gms | German Medical Science

Objective: Progress in systemic treatments has led to increased survival in many solid cancers. Unfortunately, these treatment strategies do not translate into efficient control of brain metastases and these brain metastases increasingly become the limiting factor in survival.

Method: A retrospective analysis of incidence and treatment of brain metastasis by four neurosurgical centers in a federal state of Germany from 2002 to 2013 has been carried out. Overall and post-brain metastasis survival was correlated to therapy modalities with special emphasis on surgical resection. The impact of brain metastasis and surgical resection was analyzed for >1400 lung cell carcinomas, >950 renal cell carcinomas, >1800 melanomas and >1000 breast carcinoma and GI cancer.

Results: 792 patients were neurosurgically treated for brain metastasis over a period of 10 years. Surgically treated brain metastases originated from NSCLC (37%), breast (17%), renal (6%), colon and rectal (5%) cancer, and melanoma (6%). In 6% the primary tumor remained undiagnosed (CUP). In 32%, brain metastasis led to the diagnosis of the primary cancer. Median PFS from primary tumor to metachronous brain metastasis was 25.4 months, significantly differing between primary tumors (p<0.0001), shortest for SCLC, longest for melanoma. Brain metastasis was solitary or singular in 33% each, supratentorial location in 66%, cerebellar in 26%. In 6%, both supra- and infratentorial brain metastasis were present. Resection was performed in all patients, in 5% more than 1 brain metastasis was resected. WBRT was performed before surgical intervention in 12%, following surgery in 82%. In 5% postsurgical SRS was applied. Median OAS was 167.5 months, significantly depending on the progression of the primary tumor (p<0.001), with longest OAS in breast and renal cancer, shortest for NSCLC. Median post-BM survival was 25.9 months, significantly influenced by the number of BM (p<0.0001). Neither origin of brain metastasis (p=0.9) nor mode of adjuvant radiation (p=0.6) influenced post-metastatic survival.

Conclusions: The clinical impact of a brain metastasis differs for the various primary tumors. Systemic treatment options start proving effective against brain metastasis. Therefore, the role of surgical resection may very significantly depend on tumor origins and timing.