gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

The role of surgery in the management of patients with multiple brain metastases

Meeting Abstract

  • Claudia Lindner - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Germany
  • Saskia Petschke - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Germany
  • Dietmar Krex - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Germany
  • Gabriele Schackert - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus Dresden </P>

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1644

DOI: 10.3205/10dgnc117, URN: urn:nbn:de:0183-10dgnc1179

Published: September 16, 2010

© 2010 Lindner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Because of prolonged patient survival times resulting from improved control of systemic cancer, the management of patients with brain metastases has become more and more important. For patients with single brain metastases a survival benefit of surgical resection has been validated. However, the role of surgery in the treatment of patients with multiple brain metastases (MBM) is controversially discussed.

Methods: Patients with MBM from various primaries who had been operated on in our department from 2000 to 2008 were identified. The retrospective evaluation comprised in addition to the total number and the number of resected brain metastases a set of clinical characteristics like the neurological status and the extracranial disease status. Karnofsky-status pre- and postoperative, additional and adjuvant therapies were registered and overall survival was determined. Chi-square and Kaplan-Meier-statistics were used.

Results: A total of 127 patients (78 males and 49 females) with resection of MBM were identified. The median age at diagnosis was 67 years (range 27–81). The median number of brain metastases was 3 (range 2 to >15). The most common primary tumors were lung (35%), melanoma (22%), breast (12%) and kidney (12%). 78% had active extracranial disease. In 39,4% the diagnosis of MBM was the initial finding of systemic cancer. The median interval between the diagnosis of the primary site and MBM was 11 months (range 0–240). 4,7% underwent whole brain radiation therapy (WBRT) before resection. After resection, 76% of our patients had WBRT with a median dose of 30Gy. The median Karnofsky status pre- and postoperative was 70 (range 20–90). The median overall survival after resection was 6 months (range 0–92). The initial status of extracranial disease was not found to be a predictor of overall survival. In 27% of our patients with MBM we resected all lesions (ranged from 2–4). In this group the median overall survival was 8 month (range 1–32). We found a 1 year overall survival rate of 21% in patients with MBM after the resection of at least 1 lesion. 2 years after the resection we could registrate a overall survival rate of 6,1% which was significant higher in the population of patients with total resection of all lesions.

Conclusions: Patients with MBM should have surgery for up to 4 metastases whenever possible as surgery has turned out to be an independent prognostic marker. The extent of extracranial disease was of significant predictive value in univariate analysis only.