gms | German Medical Science

Introduction: Metastases are the most frequent tumors in the brain. At the time of diagnosis, more than 50% of the cancer patients present with multiple lesions. Standard treatment comprises whole brain radiation therapy (WBRT) resulting in an overall survival time (OST) of 3-6 months. The goal of our retrospective investigation was to evaluate, whether surgery can prolong survival time even in the setting of multiple brain metastases, and to search for the main prognostic factors that influence the survival of the patients.

Materials and methods: Hundred-twenty-seven patients with multiple lesions were included in our retrospective study. All patients were operated on at least one of their lesions. 211 resections were performed. If possible, adjuvant WBRT was applied. Median follow up time was 29 months. Data acqusition was based on patient´s records, clinical cancer registry, and local health authority registry. The data were evaluated with respect to overall survival, progression free survival, RPA- and Karnofsky-classification, age, and histology of the primary tumor.

Results: The median age at diagnosis was 67 years.The median number of cerebral metastases was 3 (range: 2-5). The median OS of the whole group was 6.5 months. According to the RPA-classification the OS ranged between 19.4 months for class I, 7.8 months for class II and 3.4 months for class III patients (p <0.001). KPS >70 had a significant influence on OS (9.1 months vs 3.4 months, p<0.001), also the number of lesions: 2-4 vs >4 (p=0.009). Age was not significant in our cohort. Two- year survival rate was 15% and three- year survival rate 10%.

Conclusion: Patients with multiple brain metastases benefit from surgery. The main indications for surgery are: large lesions >3 cm with mass effect, rapid symptom relief, no more than 4 lesions, KPS>70 and RPA class I patients. Even after occurrence of multiple lesions, long-term survivors can be expected, if active treatment is applied.