Neurosurgical management of single brain metastasis

Yardeni, Dan; Reichenthal, E; Zucker, Gideon; Rubeinstein, Avi; Cohen, Martine; Israeli, J.; Shalit, M. N.

doi:10.1016/0090-3019(84)90118-6

Cited by 34 publications

(7 citation statements)

References 19 publications

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“…Many neurosurgeons believe that metastases that occur in the posterior fossa have a poor prognosis. 14,84 In 1978, Sharr and Garfield 60 reported that their 39 patients with cerebellar metastases from the lung had a median survival time of 3.1 months compared to 6.3 months for patients whose metastases occurred in the supratentorial compartment. Poor survival in patients with cerebellar metastases was also reported by Kuo, et al, 29 who reported a 1-year survival rate of 25% in a group of 11 patients with differ-ent primary tumors; none of these patients survived a 3rd year.…”

Section: Cerebellar Location Of Metastatic Lesionmentioning

confidence: 99%

“…Most neurosurgeons oppose it even when the lesions are surgically accessible. 27,49,54,74,80,81,84 However, some neurosurgeons began to operate on such patients in the early 1970s, and in 1982 Takakura and colleagues 67 presented a series of 31 patients whose multiple brain metastases were resected. The median survival in this group was 4.4 months, compared to 9 months in 94 patients with a single metastasis.…”

Section: Multiple Metastasesmentioning

confidence: 99%

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Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

Wroński

Arbit²,

Burt³

et al. 1995

Journal of Neurosurgery

202

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The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; post-operative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.

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Section: Cerebellar Location Of Metastatic Lesionmentioning

confidence: 99%

Section: Multiple Metastasesmentioning

confidence: 99%

Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

Wroński

Arbit²,

Burt³

et al. 1995

Journal of Neurosurgery

202

View full text Add to dashboard Cite

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“…Hence, the ideal candidate for excision of a single brain metastasis has minimal or no preoperative neurological deficit, no other detectable metastases, and a diagnosis of the primary tumor made at least one year earlier [7]. Yardeni et al [41] added to these criteria (a) a previously diagnosed and treated primary tumor and (b) a metastasis located in the parenchyma of the cerebral hemispheres. Based on the results of a series of 74 consecutive patients undergoing craniotomy for a single brain metastasis, they advocated surgery for every patient with a single metastasis, except those patients whose condition is terminal because of the activity of the primary tumor and/or its widespread extracranial dissemination.…”

Section: Prognosismentioning

confidence: 99%

Surgical treatment of metastatic brain tumors

et al. 1996

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The most common structural neurologic complication of systemic cancer is brain metastasis. For the most part, treatment is palliative because the majority of patients (> or = 50%) have uncontrollable systemic cancer. However, for patients in whom the only metastasis is to the brain, death is more likely to result from the metastasis than from the systemic disease; hence, treatment of the metastasis is vitally important. Although radiotherapy is generally considered the preferred treatment, surgical removal of the mass, whether single or multiple, may be the most effective palliation, especially for tumors from radio-resistant diseases such as melanoma, kidney and colon cancer. We review the information regarding therapeutic decision-making; advances in surgical procedures, namely computer-assisted stereotactic and/or intraoperative ultrasound and mapping techniques; the efficacy of postoperative WBRT; complications and benefits of surgery; our experience with reoperation for recurrent metastatic brain tumors, the results of which indicate that reoperation for recurrent brain metastasis can prolong survival and improve quality of life for most individuals; our results comparing surgery versus radiosurgery, which show that patients who undergo surgical treatment live longer and have better tumor control than those treated with radiosurgery; and the patient's prognosis. The conclusion is that surgery should remain the treatment of choice whenever possible.

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“…This poorer prognosis for patients with multiple intracranial metastases has also been seen in studies that included all RPA classes, where patients with solitary metastasis had the best prognoses (8, 18, 28, 37, 38, 40). Patients, however, rarely only have one metastasis, especially with advances in neuroimaging modalities (8, 18, 28, 37, 38, 40). Similarly, tumor size was also independently associated with poorer survival in this study, where the most significant cutoff was 2 cm.…”

Section: Discussionmentioning

confidence: 58%

Identifying Better Surgical Candidates Among Recursive Partitioning Analysis Class 2 Patients who Underwent Surgery for Intracranial Metastases

et al. 2014

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OBJECTIVE The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this system in predicting survival for RPA class 2 patients. METHODS Adult patient who underwent intracranial metastatic tumor surgery at an academic tertiary care institution from 1997 to 2011 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to identify preoperative factors associated with survival. The identified associations were then used to develop a grading system. Survival as a function of time was plotted using the Kaplan-Meier method, and survival rates were compared using log-rank analyses. RESULTS A total of 421 (59%) of 708 patients were RPA class 2. The preoperative factors found to be associated with poorer survival were: male gender (P < 0.0001), motor deficit (P = 0.0007), cognitive deficit (P = 0.0004), nonsolitary metastases (P = 0.002), and tumor size >2 cm (P = 0.003). Patients having 0–1, 2, and 3–5 of these variables were assigned a preoperative grade of A, B, and C, respectively. Patients with a preoperative grade of A, B, and C had a median survival of 17.0, 10.3, and 7.3 months, respectively. These grades had distinct survival times (P < 0.05). CONCLUSIONS The present study devised a preoperative grading system that may provide prognostic information for RPA class 2 patients, which may also guide medical and surgical therapies before any intervention is pursued.

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Neurosurgical management of single brain metastasis

Cited by 34 publications

References 19 publications

Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

Surgical treatment of metastatic brain tumors

Identifying Better Surgical Candidates Among Recursive Partitioning Analysis Class 2 Patients who Underwent Surgery for Intracranial Metastases

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