gms | German Medical Science

Objective: About 30% of all cancer patients develop brain metastases (BMs). Surgical resection is an important element in the multidisciplinary treatment pursuing three main objectives:

• a. tissue acquisition to establish a histological and molecular diagnosis
• b. removal of mass lesion to improve overall survival
• c. improvement of neurological status by decompression of eloquent brain regions.

In this study we analyzed the frequency of focal neurological deficits and the impact of resection on these impairment groups.

Methods: We analyzed 366 patients (52.7 % male; 47.3% female; median age 62.3 years) consecutively treated for BM in our department. The most frequent primary tumor was lung cancer (33.9%), followed by malignant melanoma (16.1%) and breast cancer (13.9%). Solitary BM were diagnosed in 23.7%, singular in 33.9% and multiple in 42.4% or all cases; the majority of BM (64.2%) occurred metachronously. Intratumoral hemorrhage occurred in 18.6% of all patients, while BM originating from MM displayed a significantly higher frequency of intratumoral hemorrhage (49.1%; p = 0.001). RPA classes were distributed as follows: 12.1% class 1, 76.8% class 2 and 11.1% class 3. To assess the functional status, we determined Karnofsky performance index (KPI), the neurological performance status (MRC – NPS), as well as three neurological deficits: Aphasia, hemiparesis and visual field deficits.

Results: KPI and MRC – NPS was significantly improved following surgery (p = 0.001; and p = 0.020, respectively); 16.7% of all patients presented with seizures, which were improved in all cases (100%). Aphasia was present in 16.9% of all cases, with an improvement rate of 54.2%; hemiparesis occurred in 14.8% with an improvement rate of 51.8%; vision field deficits were detected in 13.4% with an improvement rate of only 22.4%. We did not detect any difference in improvement rates between complete and incomplete resection, primary tumor or age. Interestingly, patients with improvement of hemiparesis and better RPA class following surgical resection showed significantly longer overall survival (p = 0.034).

Conclusion: Resection of brain symptomatic metastases improves focal neurological deficits and thereby improved RPA class can lead to longer overall survival.