Microsurgery vs. radiosurgery for the treatment of multiple metastases in the brain: a retrospective cohort study

Abstract

Objective: Multiple brain metastases are a severe condition for cancer patients. To date, no general consensus exists regarding the optimal treatment procedure for multiple brain metastases. Radiotherapy is the most commonly used treatment option. The role of surgical resection for multiple brain metastases is unclear. The aim of this study was to compare the outcomes of patients with multiple brain metastases treated with either surgery or stereotactic radiosurgery (SRS). Methods: The medical records of 279 consecutive adult patients with multiple brain metastases treated with either surgery (26 patients) or SRS (253 patients) were retrospectively reviewed. Propensity score matching was conducted to correct for discrepancies in the baseline characteristics, and 78 patients (26 receiving surgery and 52 receiving SRS) were chosen for comparison of outcomes, such as overall survival, local tumor control rate, and symptom improvement. Results: The tumor size in the surgery group was significantly greater than that in the SRS group after propensity score matching. However, the neurological recovery rate, incidence of leptomeningeal metastasis after surgery, 1-year local tumor control rate, and overall survival were not significantly different between groups. Conclusions: Our data demonstrate that surgery and radiosurgery have identical overall survival and local tumor control rates in patients with 2 to 4 brain metastases. Although SRS remains the primary and standard option for patients with brain metastasis, surgery offers several distinct advantages, such as establishing a diagnosis or relieving mass effects, and may additionally be beneficial in carefully selected patients with 2–4 brain metastases.

The prognostic effect of chemosensitivity on brain metastases in small-cell lung cancer: A retrospective analysis

“…However, brain as a special site of progression, the choice of local therapy or systemic therapy as the primary treatment has not been determined [21][22][23][24][25][26]. Whole brain radiation therapy (WBRT) is now the standard treatment in many guidelines [1,10].…”

Quality of Life and Role of Palliative and Supportive Care for Patients With Brain Metastases and Caregivers: A Review

“…Even patients presenting with multiple BM have viable treatment options. Surgery and radiosurgery both have comparable tumor control and survival outcomes for patients with 2–4 BM ( 11 ). Separately, a large-scale prospective study included patients with 1–10 newly diagnosed BM and found that stereotactic radiosurgery alone conferred similar survival benefit [HR 0.97, 95% CI 0.81–1.18 (less than non-inferiority margin), p = 0.78; p non-inferiority < 0.0001] and adverse event profiles for patients with a few BM or 5–10 BM ( 12 ).…”

Stereotactic Radiation Therapy for Brain Metastases: Factors Affecting Outcomes and Radiation Necrosis

“…The most recent guidelines for the management of patients with BMs provided by the European Association of Neuro-Oncology and the European Association of Medical Oncology (EANO-ESMO) from 2021 [ 2 ] remind that, for optimal therapeutic strategy planning, age, performance score, histotype, and cranial and extracranial disease status should be examined [ 3 ]. Surgery should be considered when there is doubt about the neoplastic nature, when the primary is unknown or the primary rarely generates BMs, when the change in molecular profile can affect the decision making [ 1 ], or when there are acute symptoms of increased intracranial pressure [ 4 , 5 , 6 ]. Stereotactic radiation therapy (SRT) is recommended for patients with a limited number (1 to 9) and size of BMs (typically a cumulative volume lower than 15 cc) [ 2 ] and typically with a Karnofsky performance status (KPS) ≥ 70 and stable extracranial disease [ 7 , 8 ]; SRT is also recommended after surgery for improving local control [ 9 ].…”