gms | German Medical Science

Objective: Brain metastases (BM) develop in about 40% of patients with cancer during the course of their disease. To select patients with the highest benefit from surgical resection, prognostic indices (RPA, GPA) have been formulated which are solely focussed on survival without considering neurological improvement. The goal of our study was to analyze the impact of surgical resection of BM on the neurological status in addition to overall survival in a large consecutive series of patients.

Method: We retrospectively analyzed 206 BM patients (female/male: 84/122) with a mean age of 61.1 years (range: 23.4–83.9). Exclusion criteria were biopsy only, histology other than metastasis and age younger than 18 years. Neurological deficits and quality of life and were quantified with the MRC-NPS and the Karnofsky score (KPS) respectively. In addition, signs of increased intracranial pressure (ICP), hemiparesis, visual deficits and aphasia were recorded preoperatively, at discharge and at follow-up.

Results: The most frequent primary cancer types were lung cancer (34%), malignant melanoma (14.5%), breast (13.6%) and colon cancer (9.7%). Gross total resection (GTR) was achieved in 92.2% of all patients. Only 9.7% of all patients were classified as RPA class I, 77.7% and 12.6% as RPA class II&III respectively. Surgical mortality and morbidity was 0.0% and 4.9% respectively. New neurologic deficits occurred in 6.3% of all patients. Local recurrence rate was 22.1%. The mean overall survival was 10.2 months. Multivariate analysis revealed poor RPA class and short time interval between diagnosis of cancer and the occurrence of BM as independent factors predictive for poor survival. Both, KPS and MRC-NPS improved significantly after resection, the highest improvement rate was recorded in patients presenting with increased ICP and hemiparesis. No significant improvement was achieved in visual deficits. Notably, the neurological benefits were independent of RPA class, 34.8% of RPA III patients improved to class II postoperatively.

Conclusions: Surgical resection leads to significant neurological improvement despite poor RPA class and short overall survival. Considering the low mortality and morbidity rates, resection should be considered as a valid option to increase neurological function and quality of life for patients with BM.