Skip to main content
SpringerLink
Log in

Surgery of recurrent brain metastases: retrospective analysis of 67 patients

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

Abstract

Objective

Treatment of patients with recurrent brain metastasis is one of the major challenges in neurooncology. Commonly, WBRT was applied after or as the initial treatment. Many patients received radiosurgery or their lesions were operated on. The question arises of what treatment modalities are appropriate and can be offered to the patients. In our retrospective analysis, we evaluated whether re-operation might be a useful measurement for the patients with respect to overall survival and quality of life.

Methods

We included 67 patients who were treated between 1993 and 2008 in our department. The median age was 59 years. Metastases of 11 different primaries were diagnosed. The median OST was 7.5 months.

Results

Statistically significant prognostic factors for OS were single lesions, completeness of resection, and time to recurrence, which was significantly influenced by WBRT after first operation. The one year survival rate correlated with the RPA classification: class I: 53.3 %, class II: 26.9 %, class III: 12.5 %. In 31.3 %, a second recurrence occurred which was treated by repeated surgery. Six patients survived as long-term survivors (25.7–132.2 months).

Conclusion

Surgery of recurrent brain metastasis is an important therapeutic option. A subgroup of patients, defined by prognostic factors, will profit with improvement of symptoms and prolongation of the overall survival time. Even long-term survivors can be expected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abrey LE, Olson JD, Raizer JJ, Mack M, Rodavitch A, Boutros DY, Malkin MG (2001) A phase II trial of temozolomide for patients with recurrent or progressive brain metastases. J Neurooncol 53:259–265

    Article  PubMed  CAS  Google Scholar 

  2. Akyurek S, Chang EL, Mahajan A, Hassenbusch SJ, Allen PK, Mathews LA, Shiu AS, Maor MH, Woo SY (2007) Stereotactic radiosurgical treatment of cerebral metastases arising from breast cancer. Am J Clin Oncol 30:310–314

    Article  PubMed  Google Scholar 

  3. Ammirati M, Cobbs CS, Linskey ME, Paleologos NA, Ryken TC, Burri SH, Asher AL, Loeffler JS, Robinson PD, Andrews DW, Gaspar LE, Kondziolka D, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Patchell RA, Kalkanis SN (2010) The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:85–96

    Article  PubMed  Google Scholar 

  4. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363:1665–1672

    Article  PubMed  Google Scholar 

  5. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491

    Article  PubMed  CAS  Google Scholar 

  6. Arbit E, Wronski M, Burt M, Galicich JH (1995) The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer 76:765–773

    Article  PubMed  CAS  Google Scholar 

  7. Baumert BG, Rutten I, Dehing-Oberije C, Twijnstra A, Dirx MJ, Debougnoux-Huppertz RM, Lambin P, Kubat B (2006) A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys 66:187–194

    Article  PubMed  Google Scholar 

  8. Bindal RK, Sawaya R, Leavens ME, Hess KR, Taylor SH (1995) Reoperation for recurrent metastatic brain tumors. J Neurosurg 83:600–604

    Article  PubMed  CAS  Google Scholar 

  9. Bindal RK, Sawaya R, Leavens ME, Lee JJ (1993) Surgical treatment of multiple brain metastases. J Neurosurg 79:210–216

    Article  PubMed  CAS  Google Scholar 

  10. Brocker EB, Bohndorf W, Kampgen E, Trcka J, Messer P, Tilgen W, Engenhart K, Flentje M (1996) Fotemustine given simultaneously with total brain irradiation in multiple brain metastases of malignant melanoma: report on a pilot study. Melanoma Res 6:399–401

    Article  PubMed  CAS  Google Scholar 

  11. Chen JC, Petrovich Z, Giannotta SL, Yu C, Apuzzo ML (2000) Radiosurgical salvage therapy for patients presenting with recurrence of metastatic disease to the brain. Neurosurgery 46:860–866

    PubMed  CAS  Google Scholar 

  12. Christodoulou C, Bafaloukos D, Linardou H, Aravantinos G, Bamias A, Carina M, Klouvas G, Skarlos D (2005) Temozolomide (TMZ) combined with cisplatin (CDDP) in patients with brain metastases from solid tumors: a Hellenic Cooperative Oncology Group (HeCOG) Phase II study. J Neurooncol 71:61–65

    Article  PubMed  CAS  Google Scholar 

  13. Combs SE, Schulz-Ertner D, Thilmann C, Edler L, Debus J (2004) Treatment of cerebral metastases from breast cancer with stereotactic radiosurgery. Strahlenther Onkol 180:590–596

    Article  PubMed  Google Scholar 

  14. Cooper JS, Steinfeld AD, Lerch IA (1990) Cerebral metastases: value of reirradiation in selected patients. Radiology 174:883–885

    PubMed  CAS  Google Scholar 

  15. Davey P, O’Brien PF, Schwartz ML, Cooper PW (1994) A phase I/II study of salvage radiosurgery in the treatment of recurrent brain metastases. Br J Neurosurg 8:717–723

    Article  PubMed  CAS  Google Scholar 

  16. Davey P, Schwartz ML, Scora D, Gardner S, O’Brien PF (2007) Fractionated (split dose) radiosurgery in patients with recurrent brain metastases: implications for survival. Br J Neurosurg 21:491–495

    Article  PubMed  CAS  Google Scholar 

  17. Feun LG, Lee YY, Plager C, Papadopoulos N, Savaraj N, Charnsangavej C, Benjamin RS, Wallace S (1990) Intracarotid cisplatin-based chemotherapy in patients with malignant melanoma and central nervous system (CNS) metastases. Am J Clin Oncol 13:448–451

    Article  PubMed  CAS  Google Scholar 

  18. Giorgio CG, Giuffrida D, Pappalardo A, Russo A, Santini D, Salice P, Blanco G, Castorina S, Failla G, Bordonaro R (2005) Oral temozolomide in heavily pre-treated brain metastases from non-small cell lung cancer: phase II study. Lung Cancer 50:247–254

    Article  PubMed  Google Scholar 

  19. Groen HJ, Smit EF, Haaxma-Reiche H, Postmus PE (1993) Carboplatin as second line treatment for recurrent or progressive brain metastases from small cell lung cancer. Eur J Cancer 29A:1696–1699

    Article  PubMed  CAS  Google Scholar 

  20. Hoffman R, Sneed PK, McDermott MW, Chang S, Lamborn KR, Park E, Wara WM, Larson DA (2001) Radiosurgery for brain metastases from primary lung carcinoma. Cancer J 7:121–131

    PubMed  CAS  Google Scholar 

  21. Hwu WJ, Lis E, Menell JH, Panageas KS, Lamb LA, Merrell J, Williams LJ, Krown SE, Chapman PB, Livingston PO, Wolchok JD, Houghton AN (2005) Temozolomide plus thalidomide in patients with brain metastases from melanoma: a phase II study. Cancer 103:2590–2597

    Article  PubMed  CAS  Google Scholar 

  22. Iwamoto FM, Omuro AM, Raizer JJ, Nolan CP, Hormigo A, Lassman AB, Gavrilovic IT, Abrey LE (2008) A phase II trial of vinorelbine and intensive temozolomide for patients with recurrent or progressive brain metastases. J Neurooncol 87:85–90

    Article  PubMed  CAS  Google Scholar 

  23. Kaba SE, Kyritsis AP, Hess K, Yung WK, Mercier R, Dakhil S, Jaeckle KA, Levin VA (1997) TPDC-FuHu chemotherapy for the treatment of recurrent metastatic brain tumors. J Clin Oncol 15:1063–1070

    PubMed  CAS  Google Scholar 

  24. Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141

    Article  PubMed  Google Scholar 

  25. Korinth MC, Delonge C, Hutter BO, Gilsbach JM (2002) Prognostic factors for patients with microsurgically resected brain metastases. Onkologie 25:420–425

    Article  PubMed  CAS  Google Scholar 

  26. Kwon KY, Kong DS, Lee JI, Nam DH, Park K, Kim JH (2007) Outcome of repeated radiosurgery for recurrent metastatic brain tumors. Clin Neurol Neurosurg 109:132–137

    Article  PubMed  Google Scholar 

  27. Loeffler JS, Kooy HM, Wen PY, Fine HA, Cheng CW, Mannarino EG, Tsai JS, Alexander E III (1990) The treatment of recurrent brain metastases with stereotactic radiosurgery. J Clin Oncol 8:576–582

    PubMed  CAS  Google Scholar 

  28. Muacevic A, Wowra B, Siefert A, Tonn JC, Steiger HJ, Kreth FW (2008) Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neurooncol 87:299–307

    Article  PubMed  Google Scholar 

  29. Noel G, Medioni J, Valery CA, Boisserie G, Simon JM, Cornu P, Hasboun D, Ledu D, Tep B, Delattre JY, Marsault C, Baillet F, Mazeron JJ (2003) Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer. Lung Cancer 41:333–343

    Article  PubMed  Google Scholar 

  30. Noel G, Proudhom MA, Valery CA, Cornu P, Boisserie G, Hasboun D, Simon JM, Feuvret L, Duffau H, Tep B, Delattre JY, Marsault C, Philippon J, Fohanno D, Baillet F, Mazeron JJ (2001) Radiosurgery for re-irradiation of brain metastasis: results in 54 patients. Radiother Oncol 60:61–67

    Article  PubMed  CAS  Google Scholar 

  31. Omuro AM, Raizer JJ, Demopoulos A, Malkin MG, Abrey LE (2006) Vinorelbine combined with a protracted course of temozolomide for recurrent brain metastases: a phase I trial. J Neurooncol 78:277–280

    Article  PubMed  CAS  Google Scholar 

  32. 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 280:1485–1489

    Article  PubMed  CAS  Google Scholar 

  33. Sadikov E, Bezjak A, Yi QL, Wells W, Dawson L, Millar BA, Laperriere N (2007) Value of whole brain re-irradiation for brain metastases—single centre experience. Clin Oncol (R Coll Radiol) 19:532–538

    Article  CAS  Google Scholar 

  34. Schackert G, Steinmetz A, Meier U, Sobottka SB (2001) Surgical management of single and multiple brain metastases: results of a retrospective study. Onkologie 24:246–255

    Article  PubMed  CAS  Google Scholar 

  35. Sheehan J, Kondziolka D, Flickinger J, Lunsford LD (2005) Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors. J Neurosurg 102(Suppl):247–254

    PubMed  Google Scholar 

  36. Shuto T, Fujino H, Inomori S, Nagano H (2004) Repeated gamma knife radiosurgery for multiple metastatic brain tumours. Acta Neurochir (Wien) 146:989–993

    Article  CAS  Google Scholar 

  37. Stark AM, Tscheslog H, Buhl R, Held-Feindt J, Mehdorn HM (2005) Surgical treatment for brain metastases: prognostic factors and survival in 177 patients. Neurosurg Rev 28:115–119

    Article  PubMed  Google Scholar 

  38. Sundaresan N, Sachdev VP, DiGiacinto GV, Hughes JE (1988) Reoperation for brain metastases. J Clin Oncol 6:1625–1629

    PubMed  CAS  Google Scholar 

  39. Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583–590

    Article  PubMed  CAS  Google Scholar 

  40. Wong WW, Schild SE, Sawyer TE, Shaw EG (1996) Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys 34:585–590

    Article  PubMed  CAS  Google Scholar 

  41. Wronski M, Arbit E, Russo P, Galicich JH (1996) Surgical resection of brain metastases from renal cell carcinoma in 50 patients. Urology 47:187–193

    Article  PubMed  CAS  Google Scholar 

  42. Yamanaka K, Iwai Y, Yasui T, Nakajima H, Komiyama M, Nishikawa M, Morikawa T, Kishi H (1999) Gamma Knife radiosurgery for metastatic brain tumor: the usefulness of repeated Gamma Knife radiosurgery for recurrent cases. Stereotact Funct Neurosurg 72(Suppl 1):73–80

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Technical University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    Gabriele Schackert, Konrad Schmiedel, Claudia Lindner, Mario Leimert & Matthias Kirsch

Authors
  1. Gabriele Schackert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Konrad Schmiedel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia Lindner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Leimert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthias Kirsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriele Schackert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schackert, G., Schmiedel, K., Lindner, C. et al. Surgery of recurrent brain metastases: retrospective analysis of 67 patients. Acta Neurochir 155, 1823–1832 (2013). https://doi.org/10.1007/s00701-013-1821-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1821-y

Keywords

Search

Navigation