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Multiple brain metastases: a surgical series and neurosurgical perspective

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Abstract

Despite review papers claim for radical treatment of oligometastatic patients, only few surgical series have been published. In this study, we analyze results and actual role of surgical resection for the management of patients with multiple brain metastases. This retrospective study compares surgical results of two groups of patients consecutively treated in our Institute from January 2004 to June 2015. The first group comprises all 32 patients with multiple brain metastases with only 2–3 lesions who underwent surgical resection of all lesions; the second group comprises 30 patients with a single surgically treated brain mestastasis compatible with the first group (match-paired control series). Median survival was 14.6 months for patients with multiple brain metastases (range 1–28 months) and 17.4 months for patients with a single brain metastasis (range 4–38 months); the difference was not statistically significant (P = 0.2). Neurological condition improved in 59.4% of patients with multiple metastases, it remained unchanged in 37.5% and worsened in 3.1%. In our series, selected patients with only 2–3 lesions with well-controlled systemic disease, life expectancy of more than 3 months, Karnofsky’s performance status > 60, and surgically accessible lesions, benefited from surgical treatment in terms of survival and quality of life, with reduction or disappearance of significant neurological deficits. The prognosis for these patients is similar to that of patients with a single metastasis. It seems that patients with breast cancer included in our series had the worst prognosis if compared to other histotypes.

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Authors and Affiliations

  1. DAI Neurology and Psychiatry, Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Maurizio Salvati, Maria Pia Tropeano & Vincenza Maiola

  2. Neuroscience Department, University of Siena, Siena, Italy

    Laura Lavalle

  3. Clinical Fellow Neurosurgery, King’s College Hospital, Greater London, London, UK

    Christian Brogna

  4. DAI Neurology and Psichiatry, Department of Neuroradiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Claudio Colonnese

  5. Neurosurgery Department, IRCCS NEUROMED INM, Neurochirurgia, Via Atinense, 18, 86077, Pozzilli, IS, Italy

    Alessandro Frati & Alessandro D’Elia

Authors
  1. Maurizio Salvati
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  2. Maria Pia Tropeano
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  3. Vincenza Maiola
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  4. Laura Lavalle
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  5. Christian Brogna
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  6. Claudio Colonnese
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  7. Alessandro Frati
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  8. Alessandro D’Elia
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Correspondence to Alessandro D’Elia.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Salvati, M., Tropeano, M.P., Maiola, V. et al. Multiple brain metastases: a surgical series and neurosurgical perspective. Neurol Sci 39, 671–677 (2018). https://doi.org/10.1007/s10072-017-3220-2

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  • DOI: https://doi.org/10.1007/s10072-017-3220-2

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