gms | German Medical Science

Objective: Brain metastases (BM) have traditionally been regarded as an ominous development in the natural history of cancer patients. Between 1985 and 2005, median survival of patients with BM was 7 months. Over the past decade, developments in neurosurgical techniques, stereotactic radiosurgery, and targeted therapies have increased median survival in BM to 12 months. However, patients with BM located in eloquent regions are seldomly considered candidates for neurosurgical resection due to the risk of postoperative neurological deficits.

Methods: We conducted a a post hoc analysis on data from a prospective study (MetastaSys) of patients undergoing BM resection at our institution between 2013-2016. Patients with eloquent BM underwent neurosurgical resection with intraoperative neuromonitoring, including transcranial motor evoked potentials and cortical/subcortical stimulation for motor-eloquent BM, and awake craniotomies for speech-eloquent BM. We then compared patients with eloquent and non-eloquent BM in terms of postoperative neurological deficits, local recurrence, and overall survival with a log-rank test.

Results: A total of 168 patients were included in the analysis. Of these, 43 (26%) had eloquent BM. No statistically significant difference (p=.921) was observed in the incidence of postoperative neurological deficits (9% in both cohorts). Similarly, local control was achieved in both cohorts, with 13% of local recurrence in the non-eloquent group vs. 9% in the eloquent group, p=.541. No statistically significant difference was observed in median progression free survival (25 months in the non-eloquent group vs. 29 months in the eloquent one, p=.194) and overall survival (11 months in the non-eloquent group vs. 15 months in the eloquent group, p=.260) in both groups.

Conclusion: Patients harboring eloquent BM should not be excluded from surgical therapies, as current neurosurgical techniques can provide local control without increased neurological morbidity.