Acta Neurochirurgica

, Volume 155, Issue 3, pp 389–397 | Cite as

The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study

  • Chang-Hyun Lee
  • Dong Gyu Kim
  • Jin Wook Kim
  • Jung Ho Han
  • Yong Hwy Kim
  • Chul-Kee Park
  • Chae-Yong Kim
  • Sun Ha Paek
  • Hee-Won Jung
Clinical Article - Brain Tumors



Advancements over the past generation have yielded several new treatment options for the management of brain metastases. However, surgical resection (SR) still remains the mainstay of treatment and is performed especially if decompression is required. The goal of this study was to evaluate the role of surgical resection for patients with brain metastases and to find the best indications for SR.


SR as an initial treatment was performed in 157 patients. Among the 157 patients, 109 (69.4 %) and 17 (10.8 %) underwent adjuvant whole-brain radiotherapy and radiosurgery, respectively. Thirty-one (19.7 %) patients did not undergo adjuvant treatment. Overall survival, tumour recurrence, and clinical outcomes were evaluated. The clinical situation was classified based on the recursive partitioning analysis (RPA) class and Karnofsky performance scale (KPS).


The overall median survival was 19.3 months. Median survival according to the extent of surgical resection was 20.4 months after gross total resection (GTR) and 15.1 months after subtotal resection (STR) (P = 0.016). The patients with stable primary extracranial cancer survived longer than patients with synchronous detection of extracranial cancer (P = 0.032). The RPA I class patients showed longer survival than the RPA II class patients (P = 0.047). This difference was more prominent in the GTR group than in the STR group (GTR, P = 0.022; STR, P = 0.075). The KPS score of the GTR group changed from 82.3 to 87.0 and that of the STR group changed from 79.2 to 77.1 (P = 0.001). Adjuvant treatment did not lead to a significant improvement in the survival and clinical outcome.


Surgical resection may accomplish satisfactory outcomes with technical advancement. The best indications for SR for brain metastasis are RPA I class, stable extracranial cancer, and a planned GTR of the tumour. Even with the advancements in adjuvant therapy, surgical resection plays a major role in the management of brain metastasis.


Brain Metastasis Surgery Survival Outcome 



The authors have no financial interests in the subject under discussion in this article.

Conflicts of interest



  1. 1.
    American Cancer Society (2012) Cancer Facts and Figures 2012, Accessed 1 Oct 2012
  2. 2.
    Al-Shamy G, Sawaya R (2009) Management of brain metastases: the indispensable role of surgery. J Neurooncol 92:275–282PubMedCrossRefGoogle Scholar
  3. 3.
    Armstrong JG, Wronski M, Galicich J, Arbit E, Leibel SA, Burt M (1994) Postoperative radiation for lung cancer metastatic to the brain. J Clin Oncol 12:2340–2344PubMedGoogle Scholar
  4. 4.
    Caroli M, Di Cristofori A, Lucarella F, Raneri FA, Portaluri F, Gaini SM (2011) Surgical brain metastases: management and outcome related to prognostic indexes: a critical review of a ten-year series. ISRN Surg 2011:207103PubMedGoogle Scholar
  5. 5.
    Chao J (1954) WBRT as a primary treatment of brain metastasis based on its good palliative effect shown in more than 60 % of cases. Cancer 7:682–689PubMedCrossRefGoogle Scholar
  6. 6.
    Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751PubMedCrossRefGoogle Scholar
  7. 7.
    Gates M, Alsaidi M, Kalkanis S (2012) Surgical Treatment of Solitary Brain Metastases. In: Kim DG, Lunsford LD (eds) Current and Future Management of Brain Metastasis. Karger, Basel, pp 74–81CrossRefGoogle Scholar
  8. 8.
    Grant FC (1926) Concerning intracranial malignant metastasis. Ann Surg 84:635–646PubMedGoogle Scholar
  9. 9.
    Haar F, Patterson RH Jr (1972) Surgical for metastatic intracranial neoplasm. Cancer 30:1241–1245PubMedCrossRefGoogle Scholar
  10. 10.
    Han JH, Kim DG, Oh CW, Kim CY, Kim YH, Park JH, Kim EK, Jung HW (2012) Progression of the lung cancer primary correlates with the identification of new brain metastases after initial radiosurgery. J Neurooncol 106:161–167PubMedCrossRefGoogle Scholar
  11. 11.
    Lenz M (1931) The palliative effect of radiation therapy in breast cancer with increased intracranial pressure. Ann Surg 93:278–293PubMedCrossRefGoogle Scholar
  12. 12.
    Mut M (2012) Surgical treatment of brain metastasis: a review. Clin Neurol Neurosurg 114(1):1–8PubMedCrossRefGoogle Scholar
  13. 13.
    Nabors LB (2012) The National Comprehensive Cancer Network guidelines for central nervous system cancers, Accessed 1 Oct 2012
  14. 14.
    Oldberg E (1933) Surgical considerations of carcinomatous metastases of the brain. JAMA 101:1458–1462CrossRefGoogle Scholar
  15. 15.
    Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489PubMedCrossRefGoogle Scholar
  16. 16.
    Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500PubMedCrossRefGoogle Scholar
  17. 17.
    Rades D, Hornung D, Veninga T, Schild SE, Gliemroth J (2011) Single brain metastasis: radiosurgery alone compared with radiosurgery plus up-front whole-brain radiotherapy. Cancer 118:2980–2985PubMedCrossRefGoogle Scholar
  18. 18.
    Sahgal A, Ma L, Chang E, Shiu A, Larson DA, Laperriere N, Yin FF, Tsao M, Menard C, Basran PS, Letourneau D, Heydarian M, Beachey D, Shukla V, Cusimano M, Hodaie M, Zadeh G, Bernstein M, Schwartz M (2009) Advances in technology for intracranial stereotactic radiosurgery. Technol Cancer Res Treat 8:271–280PubMedGoogle Scholar
  19. 19.
    Shaffrey ME, Mut M, Asher AL, Burri SH, Chahlavi A, Chang SM, Farace E, Fiveash JB, Lang FF, Lopes MB, Markert JM, Schiff D, Siomin V, Tatter SB, Vogelbaum MA (2004) Brain metastases. Curr Probl Surg 41:665–741PubMedCrossRefGoogle Scholar
  20. 20.
    Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int J Radiat Oncol Biol Phys 47:291–298PubMedCrossRefGoogle Scholar
  21. 21.
    Utsuki S, Miyoshi N, Oka H, Miyajima Y, Shimizu S, Suzuki S, Fujii K (2007) Fluorescence-guided resection of metastatic brain tumors using a 5-aminolevulinic acid-induced protoporphyrin IX: pathological study. Brain Tumor Pathol 24:53–55PubMedCrossRefGoogle Scholar
  22. 22.
    Yoo H, Kim YZ, Nam BH, Shin SH, Yang HS, Lee JS, Zo JI, Lee SH (2009) Reduced local recurrence of a single brain metastasis through microscopic total resection. J Neurosurg 110:730–736PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Chang-Hyun Lee
    • 1
  • Dong Gyu Kim
    • 2
  • Jin Wook Kim
    • 2
  • Jung Ho Han
    • 1
  • Yong Hwy Kim
    • 2
  • Chul-Kee Park
    • 2
  • Chae-Yong Kim
    • 1
  • Sun Ha Paek
    • 2
  • Hee-Won Jung
    • 2
  1. 1.Department of NeurosurgerySeoul National University Bundang HospitalSeongnamSouth Korea
  2. 2.Department of NeurosurgerySeoul National University Hospital, Seoul National University College of MedicineSeoulRepublic of Korea

Personalised recommendations