Article
Is there a place for surgery in recurrent brain metastasis?
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Authors
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G. Schackert
- Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
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K. Schmiedel
- Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
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C. Lindner
- Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
| Published: | April 28, 2011 |
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Outline
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Objective: Brain metastases are the most frequent tumors within the brain, accounting for about 40% of all cerebral lesions. Standard treatment includes surgery, radiosurger, and whole brain radiotherapy. Factors determining the adequate treatment are mainly depending on the KPS and age of the patient, but also on the number, size and site of the lesions. Treatment options for recurrent brain metastasis are still controversial, especially the value of surgical excision. The goal of our study was to determine the prognostic factors that influence the outcome and survival of the patients together with appropriate adjuvant treatment strategies.
Methods: In our retrospective analysis, we evaluated all patients that were operated on recurrent cerebral metastases between 1993 and 2008. Included were only patients, in which the lesions were accessible without causing new neurological deficits and in which no residual tumor was left after the first operation. Sixty-seven patients with an independent recurrence of a brain metastasis were included in our study, 33 males and 34 females. The median age was 57.9 years (31 - 76). The median interval between the first operation and the recurrence was 183 days. The most frequent primaries were malignant melanoma (12), breast-Ca and colorectal Ca (11 cases each), NSCLC (10), CUPs (9) and others (16).
Results: The median survival time of the whole group was 6.4 months. Thirty-one percent developed a second recurrence, of which 76.2% have been re-operated. The interval between the first operation and the re-operation significantly influenced the overall survival time (p=0.014), whereas the number and site (distant or local) of the recurrent tumor growth did not. In 67.2% of the patients, the KPS was stable or improved after surgery. Patients with a preoperative KPS ≤ 70 lived significantly longer than those with KPS<70 (203 vs 118 days, p=0.011). WBRT after second operation was without benefit for the patients. However, WBRT after the first operation significantly prolonged the recurrence-free survival (p=0.007).
Conclusions: For patients with recurrent brain metastases, surgery is an option. Patients may profit from active treatment, especially, when the prognostic factors are respected.
