gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Repetitive surgery on local recurrent brain metastases – a widespread problem?

Meeting Abstract

  • Anna-Margarete Bohrer - Clinic of Neurosurgery University Hospital Essen, Germany
  • Oliver Müller - Clinic of Neurosurgery University Hospital Essen, Germany
  • Ramazan Jabbarli - Clinic of Neurosurgery University Hospital Essen, Germany
  • Daniela Pierscianek - Clinic of Neurosurgery University Hospital Essen, Germany
  • Ulrich Sure - Clinic of Neurosurgery University Hospital Essen, Germany
  • Nicolai El Hindy - Clinic of Neurosurgery University Hospital Essen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.17.04

doi: 10.3205/16dgnc338, urn:nbn:de:0183-16dgnc3380

Published: June 8, 2016

© 2016 Bohrer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: There is ongoing discussion about surgical resection of brain metastases (BM). It has been claimed that circumferential stripping of BM is insufficient in achieving local tumour control and supramarginal resection might facilitate improved tumour control. The aim of our investigation was to evaluate the amount of local recurrent BM after conventional microsurgical circumferential stripping in a single center.

Method: All patients treated for BM in our department between 2009 and 2015 were identified. Data of patients that underwent repetitive surgery (RS) due to local recurrent brain metastases (LRBM) were analysed with respect to basic clinical data like age, sex, histology. Outcome was categorised using modified Rankin Scale (mRS). Descriptive statistics were used to present their data.

Results: Between 2009 and 2015, 571 patients were treated surgically for BM. Only in 27 (4.73%) patients, RS due to LRBM was necessary. 21 (77.78%) patients received one, 3 (11.11%) patients two and 3 (11.11%) patients three RS, respectively. Primary tumours in descending order were non-small lung cancer in 11 (40.7%) cases, malignant melanoma in 7 (25.9%) cases, breast carcinoma in 3 (11.1%) cases, germ cell tumors in 2 (7.4%) cases, small-cell lung cancer, sarcoma, rectal carcinoma, as well as Ewing sarcoma each in 1 (3.7%) case. Median time between first and second RS was 240 days (range 30 to 727 days); median time between second RS and exitus was 169 days (range 3 to 517 days). 7 (25.9%) patients are still alive after RS. According to mRS, even after three RS, mRS did not change after surgery. In 9 (33.33%) of the 27 patients, first LRBM was only detected in routine follow-up MRI scans, without neurological deterioration.

Conclusions: Conventional, circumferential stripping of brain metastases seems to be sufficient to gain local tumour control, with only 4.73% local recurrent brain metastases. Even repetitive surgery is sufficient to gain further tumour control without change in mRS. Follow-up MRI seems to be crucial to detect tumour progression as one third of patients did not deteriorate neurologically, despite progressive brain metastasis.