Article
Investigation of the infiltration zone of brain metastases from various primaries: preliminary data of a prospective monocentric study
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Published: | April 28, 2011 |
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Objective: It has long been believed that brain metastases are well circumscribed lesions without an infiltration zone, and are thus a good target for surgical treatment. Recent publications demonstrated that there is an infiltration zone around brain metastases as well and that the depth of infiltration may vary between the different primaries. The goal of our prospective study was to investigate the infiltration zone around cerebral metastases of different primaries by taking biopsies out of the surrounding tissue.
Methods: Between 2009 and 2010, 23 patients with brain metastases of different primaries, located in non-eloquent areas were enrolled in a prospective clinical trial after written consent. The study was approved by the local ethics committee, No 102042009. During surgery, whenever possible, en-bloc resection was performed. At the end of the procedure, biopsies were taken out of the adjacent tissue for histopathological examination. All tissues were examined for infiltration of cancer cells by immunohistochemistry. SPSS was applied for statistics.
Results: Altogether 14 men and 9 women with brain metastases were enrolled in our study. The most common primaries were: lung (35%), kidney (17%) and malignant melanoma (13%). The median age was 58 years (range 29-78). All patients had an early MRI with contrast medium within 48 hours after surgery, confirming the complete resection of tbe lesion. In 7 patients (30.4%), tumor cells were detected in at least one of the biopsies. The distribution between the different primaries was equal and therefore not significant.
Conclusions: Despite microscopically complete resection of brain metastases confirmed by early MRI, we demonstrate that tumor cells infiltrate the adjacent tissue. In our study the depth of the infiltration zone was not verified. An enlargement of our cohort is necessary, in order to answer the question, as to whether the infiltration zone varies between metastases of different primaries, which might have an implication for future surgical strategies.