gms | German Medical Science

Objective: Brain metastases is the most common cerebral tumor in adults. The improvement of overall survival in patients with brain metastases requires the best possible conditions for local tumor control and prevention of neurological deficits. This can be achieved by surgical resection for a subset of patients.

Method: Clinical data of patients with cerebral metastases, who had pre- and postoperative MRIs were retrospectively assessed. Age, sex, survival after surgery, pre- and postoperative Karnofsky-Performance-Status-Scale, tumor localization, and histopathological result were recorded. Included patients underwent surgery within the last three years (12/2008-05/2012).

Results: 124 patient were included, 68 female and 56 male between 21 and 83 years. The mean age was 60. Melanoma, breast cancer and NSCLC provided the three most common primary tumors. 53.2 % had solitary brain metastases, 42.8% multiple. Gross total resection was conducted in 89.5%. The mean time between the first diagnosis of the primary tumor and surgery was 43 months. Mean survival for patients with preoperative Karnofsky-Performance-Status-Scale <70% was 3.6 months, for those with >70% 18.8 months (p < 0.05, log rang). Permanent neurological postoperative deterioration was observed in 8.9%. Median overall survival after resection of brain metastases for all patients was 8.3 months.

Conclusions: Since metastatic brain disease shows a high and still increasing incidence with better treatment, better imaging and ageing population, the surgical treatment of brain metastases is very relevant According to our patient cohort, the Karnofsky-Performance-Status-Scale seems to be the most important factor for survival in patients with metastatic brain disease. Other parameters such as the number of cerebral metastases, the extent of resection and postoperative deterioration showed a statistical trend for a positive influence of median survival.