Surgery of recurrent brain metastases: retrospective analysis of 67 patients

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

doi:10.1007/s00701-013-1821-y

Cited by 38 publications

(29 citation statements)

References 40 publications

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“…Moreover, the study should provide a basis upon which other local salvage treatment concepts, such as OTR, could be compared to. In a mere comparison of survival data, PRS rates after OTR are comparable to our PRS rates after salvage CyberKnife: retrospective data on salvage OTR suggest a PRS range between 7.5 and 12.9 months [4-5]. These ranges are determined by disease- and patient-specific differences.…”

Section: Discussionsupporting

confidence: 71%

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Romagna¹,

Schwartz

Ladisich

et al. 2018

Cureus

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IntroductionLocal treatment concepts are in high demand in the salvage treatment of recurrent brain metastases. Still, their risks and benefits are scarcely characterized. In this study, we analyzed the outcome and risk-/benefit-ratio of salvage CyberKnife (Accuray Incorporated, Sunnyvale, California, US) radiosurgery in the treatment of recurrent brain metastases after whole brain radiotherapy (WBRT).Materials and methodsSeventy-six patients with 166 recurrent brain metastases and a multimodal pretreatment were retrospectively investigated. All patients underwent salvage CyberKnife radiosurgery (single fraction, reference dose: 17-22 Gy). Study endpoints were post-recurrence survival (PRS) after salvage treatment as well as local and distant tumor control rates. Central nervous system (CNS) toxicity was assessed according to the toxicity criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC)).ResultsThe population was homogenous regarding its demographic parameters. All patients had a history of WBRT prior to salvage CyberKnife radiosurgery. PRS was 13.3 months (10.4 - 16.2 months), one-year local and distant tumor control rates were 87% (95% CI: 75-99) and 38% (95% CI: 23-52), respectively. Eighteen patients suffered from RTOG/EORTC grade I/II toxicity. No toxicity-related risk factors were identified.DiscussionThis study found indicative survival and tumor control rates as well as a favorable risk/benefit ratio regarding radiotoxicity in salvage CyberKnife radiosurgery. These results point to a proactive therapeutic strategy based on appropriate patient selection instead of therapeutic nihilism.

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Section: Discussionsupporting

confidence: 71%

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Romagna¹,

Schwartz

Ladisich

et al. 2018

Cureus

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“…The major argument for surgery in this patient cohort may be seen in the clinical improvement which is, in line with the current literature, the strongest predictor for further survival after recurrent BM treatment [4,8,16].…”

Section: Discussionsupporting

confidence: 79%

“…However, the role of surgery for pretreated, recurrent BM is not yet de ned, and only scarce data, originating from the premolecular era, are available. Only a few studies have reported on the feasibility of (re-)surgery in patients with single or multiple recurrent BM [8,9,13,14]. They included narrowly de ned patient cohorts previously treated by either surgery [8,15] or sRS [14,16], and reported median survival rates after resection of between 7.5 and 11.5 months.…”

Section: Discussionmentioning

confidence: 99%

“…Although BM are considered, in principle, a fatal event for oncological patients, treatment paradigms are changing and affected patients are nowadays frequently treated with repeated non-invasive therapeutic procedures such as radiotherapy and systemic oncological treatments. While the role of neurosurgical resection of primary and symptomatic BM is clearly de ned [5,6], the application of surgery for recurrent BM, especially after previous multimodal treatments, remains an individual decision [7], particularly since underlying studies [8,9] are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Brain Metastases: The Role of Resection of in the Era of Molecular Medicine

Hessler

Jünger

Meißner

et al. 2021

Preprint

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Purpose To evaluate the efficacy of surgical resection for pretreated, recurrent brain metastases (BM) in the era of molecular oncologic medicine. Patients and Methods: In a retrospective single center study, patients were analyzed who had undergone surgical resection of recurrent BM between 2007 and 2019. Intracranial event-free survival (EFS) and overall survival (OS) were evaluated by Kaplan-Maier and Cox regression analysis. Results In total, 107 patients with different primary tumor entities and individual previous treatment for BM were included. Primary tumors comprised non-small cell lung cancer (NSCLC) (37.4%), breast cancer (19.6%), melanoma (13.1%), gastro-intestinal cancer (10.3%) and other, rare entities (19.6%). The number of previous treatments of BM ranged from one to four; these comprised: resection only, focal or whole brain radiotherapy, brachytherapy and radiosurgery. BM-related symptoms were present in 73.8% of the patients. Median pre-operative Karnofsky Performance Score (KPS) was 70% (range 40–100) which was improved to 80% (range 0-100) after surgery. The complication rate was 26.2% and two patients died during the perioperative period. Postoperative local radio-oncologic and/or systemic therapy regimens were applied in 67 (62.6%) patients. Median postoperative EFS and OS were 7.1 (95%CI 5.8–8.2) and 11.1 (95%CI 8.4–13.6) months, respectively. The clinical status (postoperative KPS ≥ 70 (HR 0.27 95%CI 0.16–0.46; p < 0.001) remained the only independent factor for survival in multivariate analysis. Conclusion Surgical resection of recurrent BM may improve the clinical status and thus OS, but is associated with a high complication rate; thus, careful patient selection is crucial.

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“…Median OS after upfront STI was 37.5 months for all 48 patients, 37.5 months for recurrences with pure or combined histology (n = 42), and 40.3 months for patients with pure radiation necrosis (n = 6) (p = 0.13). Median OS noted in previously published studies was much lower at 7.5 to 19 months (Table 4) [10,11,[17][18][19][20]. The longer median survival in our study can be attributed to the development of systemic therapy, improved care of cancer patients, and advances in surgical techniques.…”

Section: Discussionmentioning

confidence: 39%

Retrospective analysis of salvage surgery for local progression of brain metastasis previously treated with stereotactic irradiation: diagnostic contribution, functional outcome, and prognostic factors

et al. 2020

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Background: Stereotactic irradiation (STI) is a primary treatment for patients with newly diagnosed brain metastases. Some of these patients experience local progression, which is difficult to differentiate from radiation necrosis, and difficult to treat. So far, just a few studies have clarified the prognosis and effectiveness of salvage surgery after STI. We evaluated the diagnostic value and improvement of functional outcomes after salvage surgery. Based on these results, we reconsidered surgical indication for patients with local progression after STI. Methods: We evaluated patients with brain metastases treated with salvage surgery for local progression from October 2002 to July 2019. These patients had undergone salvage surgery based on magnetic resonance imaging findings and/or clinical evidence of post-STI local progression and stable systemic disease. We employed two prospective strategies according to the eloquency of the lesions. Lesions in non-eloquent areas had been resected completely with a safety margin, utilizing a fence-post method; while lesions in eloquent areas had been treated with minimal resection and postoperative STI. Kaplan-Meier curves were used for the assessment of overall survival. Prognostic factors for survival were analyzed. Results: Fifty-four salvage surgeries had been performed on 48 patients. The median age of patients was 63.5 years (range 36-79). The median interval from STI to surgery was 12 months. The median overall survival was 20.2 months from salvage surgery and 37.5 months from initial STI. Primary cancers were lung 31, breast 9, and others 8. Local recurrence developed in 13 of 54 lesions (24%). Leptomeningeal dissemination occurred after surgery in 3 patients (5.6%). Primary breast cancer (breast vs. lung: HR: 0.17), (breast vs. others: HR: 0.08) and RPA class 1-2 (RPA 1 vs. 3, HR:0.13), (RPA 2 vs 3, HR:0.4) were identified as good prognostic factors for overall survival (OS) in multivariate analyses. The peripheral neutrophil-to-lymphocyte ratio (NLR) of ≤3.65 predicted significantly longer OS (median 25.5 months) than an NLR > 3.65 (median 8 months).

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Surgery of recurrent brain metastases: retrospective analysis of 67 patients

Abstract: 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.

Cited by 38 publications

References 40 publications

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks?

Recurrent Brain Metastases: The Role of Resection of in the Era of Molecular Medicine

Retrospective analysis of salvage surgery for local progression of brain metastasis previously treated with stereotactic irradiation: diagnostic contribution, functional outcome, and prognostic factors

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