gms | German Medical Science

Objective: The new surgical strategy of supramarginal resection for brain metastases (BM) is believed to reduce the risk of local recurrence and to prolong postmetastatic survival rates.

Methods: Between 2008 and 2016 a total of 274 patients were surgically treated for BM. Recurrence-free survival rates (RFS) were correlated to the technique of BM resection (en bloc vs. piece-meal with or without supramarginal resection), postsurgical radiation as well as treatment years.

Results: 142 patients were male, mean age was 61.8 years, significantly differing between gender (p<0.001). 201 BM were supratentorial, 46.7% originated from lung cancer. In 22 (9%) BM were of incidental finding, 40.5% had symptoms of elevated ICP, 10% presented with seizures and 40.5% had neurological deficits. Postsurgically, symptoms were unchanged in 30%, improved in 55.2%, and worsened in 14.8%. Mean postmetastatic survival was 19.7 months, significantly correlating to tumor origin (longest for CUP, kidney and breast cancer, shortest for colorectal cancer, p=0.0109).

For 123 patients, a complete MR image follow-up was available, with a mean follow-up of 22 months. 68% received postsurgical WBRT, 32% tumor-bed RT. Tumor-bed RT was only performed after January 2012. 33 patients (26.8%) experienced a local recurrence, median recurrence-free survival time (RFS) was 15.63 months, median time to recurrence was 7.63 months. 63.4% received en bloc BM resection, in 36.6% surgery was done in a piece-meal manner. In 33% supramarginal resection was done.

Supramarginal resection or en bloc technique had no positive influence on RFS or postmetastatic survival. Neurological outcome did not differ either. A clear trend towards longer RFS was seen for the kind of applied postsurgical radiation therapy: 60-months RFS rates of 72.6% for tumor-bed RT and 58% for WBRT (p=0.222). Patients treated before 2012 had a median RFS of 28.2 months, whereas the 48-months RFS rates where 63% and 75% in those treated from 2012–14 or 2015–16 (p=0.132). Median postmetastatic survival was better after tumor-bed RT (46.12 months) than post WBRT (22.63 months; p=0.12).

Conclusion: Supramarginal resection of BM is a safe procedure, but does not seem to influence the RFS or postmetastatic survival times. Postsurgical tumor-bed RT seems favourable over WBRT. Encouragingly, prolonged RFS and postmetastatic survival come with recent treatment years. The influence of newer systemic therapy has to be considered in our analyses.