Article
Immer die Resektion zuerst - Resection first?
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Authors
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Gabriele Schackert
- Klinik und Poliklinik für Neurochirurgie, TU Dresden, Berlin, Deutschland
| Published: | March 20, 2006 |
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Outline
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Introduction: About 30% of all brain tumors are metastases; thus they form the most common brain tumors. The treatment strategies comprise surgery, radiosurgery, radiotherapy and chemotherapy. The indications for the different treatment modalities depend on prognostic factors, e.g. age, Karnofsky Score, control of the primary tumor site, and extent of extracerebral metastases. These factors are represented in the RPA classification (recursive partitioning analysis) of the RTOG.
Methods and Results: It has been shown in retrospective and prospective trials that surgical resection of brain metastasis followed by WBRT (Whole Brain Radiation Therapy) prolongs the survival time of patients with brain metastasis compared to WBRT alone. The indication for surgery as treatment of first choice is established for lesions of more than three centimeters in diameter, for those that can be safely approached by surgery, and for those of the posterior fossa. Also metastases of the skull base should be resected in an interdisciplinary approach. The median survival time of our own evaluated patients is comparable to those of patients with intraparenchymal lesions. In multiple metastases, there is an indication for surgery, if the lesions are accessible and their number does not exceed three, the Karnofsy Score being > 70 and the age < 60yrs.
Patients suffering of extensively anchored metastases of the skull base, miliary metastases as well as multimorbid patients should not undergo surgical resection. If possible, the histology of the tumor should be confirmed by stereotactic biopsy.
Radiosurgery as local focused therapy is comparable to surgery. The indication for both treatment options differ with respect to the size and site of the lesions. WBRT should be applied as palliative treatment in patients with multiple metastases and in those with multimorbidity and advanced age.
Conclusions: Patients with brain metastases profit from aggressive therapy. An exact scoring of the stage of metastasizing is necessary. Longterm survivors of more than 10 years are known.
