Multiple brain metastases: a surgical series and neurosurgical perspective

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.

HER2‐positive breast cancer brain metastasis: A new and exciting landscape

“…74 Neurosurgical resection offers survival benefit when associated with adjuvant radiation therapy, more so in patients with good performance status, controlled systemic disease, and a solitary brain lesion. [75][76][77] While SRS is preferred F I G U R E 1 Suggested algorithm for multidisciplinary management of care for patients with HER2+ breast cancer brain metastases. BCBrM: breast cancer brain metastases; MBC: metastatic breast cancer; THP: Taxotere (Docetaxel) + Herceptin (Trastuzumab) + Perjeta (Pertuzumab); T-DM1: ado-trastuzumab emtansine (Kadcyla) in cases with a limited number of BrM, the upper limit of number of lesions remains controversial.…”

Brigatinib treatment for primary lung lesions in non-small-cell lung cancer based on ALK gene rearrangement detected in resected brain metastases: A case report and literature review

“…For patients who cannot tolerate surgery due to poor physical condition, SRT, or WBRT can be considered. For patients with multiple brain metastases or contraindications for surgery, WBRT is the first choice, and SRT with adjuvant chemotherapy may be suitable in some cases [9][10][11]3]. Because some patients are at risk due to intracranial hypertension, the treatment order is important.…”

WBRT for brain metastases from non-small cell lung cancer: for whom and when?—Contemporary point of view

“…Surgery is of value for relieving the mass effect in symptomatic BM, as well as in case of single BM amenable to radical surgery in patients with controlled extracranial disease and good performance status. Surgery results in a high rate of relief symptoms in 60-90% of patients and improving the local control (39,40). The WBRT is used as adjuvant modality after surgery or as primary treatment to improve local control (41,42).…”