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

  • Clinical Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

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

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Chang-Hyun Lee, Jung Ho Han & Chae-Yong Kim

  2. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Dong Gyu Kim, Jin Wook Kim, Yong Hwy Kim, Chul-Kee Park, Sun Ha Paek & Hee-Won Jung

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  1. Chang-Hyun Lee
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  2. Dong Gyu Kim
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Correspondence to Dong Gyu Kim.

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Lee, CH., Kim, D.G., Kim, J.W. et al. The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study. Acta Neurochir 155, 389–397 (2013). https://doi.org/10.1007/s00701-013-1619-y

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  • DOI: https://doi.org/10.1007/s00701-013-1619-y

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