Resection of brain metastases previously treated with stereotactic radiosurgery

Abstract

Sixty-one patients (each harboring three or fewer brain lesions), who were treated at a single institution between June 1993 and August 2002 were identified. Patient charts and their neuroimaging and pathological reports were retrospectively reviewed to determine overall survival rates, surgical complications, and recurrence rates. A univariate analysis revealed that patient preoperative recursive partitioning analysis (RPA) classification, primary disease status, preoperative Karnofsky Performance Scale score, type of focal treatment undergone for nonindex lesions, and major postoperative surgical complications were factors that significantly affected survival (p < or = 0.05). In contrast, only the RPA class and focal (conventional surgery or SRS) treatment of nonindex lesions significantly (or nearly significantly) affected survival in the multivariate analysis. Major neurological complications occurred in only 2% of patients. The median time to distant recurrence after resection was 8.4 months; that to local recurrence was not reached. The overall median survival time was 11.1 months, with 25% of patients surviving 2 or more years. Conventional surgery facilitated tapering of steroid administration. Conclusions. The complication, morbidity, survival, and recurrence rates are consistent with those seen after conventional surgery for recurrent brain metastases. Our results indicate that in selected patients with a favorable RPA class in whom nonindex lesions are treated with focal modalities, surgery can provide long-term control of SRS-treated lesions and positively affect overall survival.

Stereotactic Interstitial Radiosurgery With the Photon Radiosurgery System (PRS) for Metastatic Brain Tumors: A Prospective Single-Center Clinical Trial

“…In single metastasis, PRS has been introduced as an alternative treatment option (17), although treatment of tumors with irregular borders or localization in less accessible intracranial regions still requires external stereotactic radiosurgery with Linac or Gamma Knife (5,33). Patients with large tumors and distinct edema benefit from surgery, combined with WBRT, which offers quickly recovery of neurological symptoms, leading to a lower consumption of steroids (34)(35)(36).…”

A new paradigm in treatment of brain metastases

“…Another series of 45 patients receiving one or more courses of salvage SRS for new lesions after initial management with SRS plus or minus WBRT found one year local control of 92%, while the median survival was 6.5 months [14]. Surgical resection of 1-3 recurrent or progressive metastases initially treated with SRS has also been described in a series of 61 patients, as an alterative to WBRT [143]. The median survival after salvage surgery was 11 months.…”

Strategy of surgery and radiation therapy for brain metastases

“…In patients with recurrence, MST after the second surgery is reportedly 11.5 months, 19 whereas MST after surgery in patients with recurrence after gamma knife radiosurgery is 11.1 months. 20 In a study reported before 1990, when additional gamma knife treatment was not available, patients with recurrences after WBRT at 30 Gy received another WBRT at 25 Gy. Therapeutic effi cacy was achieved in 42% of these patients, and MST was 5 months, although there was no detailed discussion of safety.…”

“…However, additional stereotactic irradiation was actually performed in 9 and 19 patients, respectively; salvage therapy could not be conducted in all patients with tumor recurrence. The mean memory test score (maximum score, 30 points) on the mini-mental state examination (MMSE) in patients who survived for more than 1 year was 27.0 (range, [23][24][25][26][27][28][29][30] in the combined group and 28.0 (range, [18][19][20][21][22][23][24][25][26][27][28][29][30] in the SRS-alone group, showing no signifi cant difference between the two groups. Thus, SRS combined with WBRT did not increase the incidence of dementia as compared with SRS alone.…”