Surgery for brain metastases: An analysis of outcomes and factors affecting survival

Sivasanker, Masillamany; Madhugiri, Venkatesh S; Moiyadi, Aliasgar; Shetty, Prakash; Subi, T S

doi:10.1016/j.clineuro.2018.03.011

Cited by 20 publications

(26 citation statements)

References 24 publications

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“…There are many instances when prompt surgical resection is advised. 48 , 49 Tumors that demonstrate rapid growth, impose a mass effect on surrounding tissues, and/or precipitate edema are among the most urgent surgical candidates. 17 Furthermore, a larger tumor (diameter > 4 cm) in a noneloquent location is typically removed by surgery before radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Management of brain metastasis. Surgical resection versus stereotactic radiotherapy: a meta-analysis

Krist

Naik

Thompson

et al. 2022

Neuro-Oncology Advances

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Background Treatment of metastatic brain tumors often involves radiotherapy with or without surgical resection as the first step. However, the indications for when to use surgery are not clearly defined for certain tumor sizes and multiplicity. This study seeks to determine whether resection of brain metastases versus exclusive radiotherapy provided improved survival and local control in cases where metastases are limited in number and diameter. Methods According to PRISMA guidelines, this meta-analysis compares outcomes from treatment of a median number of brain metastases ≤4 with a median diameter ≤4 cm with exclusive radiotherapy versus surgery followed by radiotherapy. Four randomized control trials and 11 observational studies (1693 patients) met inclusion criteria. For analysis, studies were grouped based on whether radiation involved stereotactic radiosurgery (SRS) or whole-brain radiotherapy (WBRT). Results In both analyses, there was no difference in survival between surgery ±SRS versus SRS alone two years after treatment (OR 1.89 (95% CI: 0.47 - 7.55, p = 0.23) or surgery + WBRT versus radiotherapy alone (either WBRT and/or SRS) (OR 1.18 (95% CI: 0.76 – 1.84, p = 0.46). However, surgical patients demonstrated greater risk for local tumor recurrence compared to SRS alone (OR 2.20 (95% CI: 1.49 - 3.25, p < 0.0001)) and compared to WBRT/SRS (OR 2.93; 95% CI: 1.68 - 5.13, p = 0.0002). Conclusion The higher incidence of local tumor recurrence for surgical patients suggests that more prospective studies are needed to clarify outcomes for treatment of 1-4 metastasis less than 4 cm diameter.

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Section: Discussionmentioning

confidence: 99%

Management of brain metastasis. Surgical resection versus stereotactic radiotherapy: a meta-analysis

Krist

Naik

Thompson

et al. 2022

Neuro-Oncology Advances

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“…The use of surgery in RCC BM is limited to fit patients, usually at a younger age, less symptomatic, with a Karnofsky Performance Status (KPS) of more than 80, and most importantly, with no more than three metastases. Although there are reports of resection of multiple brain metastasis (8), most of the data available is for patients with one resectable brain metastasis (9). Median survival of patients after craniotomy ranges between 8.5-12.6 months in various reports (4,7,8).…”

mentioning

confidence: 99%

“…Although there are reports of resection of multiple brain metastasis (8), most of the data available is for patients with one resectable brain metastasis (9). Median survival of patients after craniotomy ranges between 8.5-12.6 months in various reports (4,7,8).…”

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confidence: 99%

Do we have a “game changer” in treating patients with brain metastasis from renal cell carcinoma?

Vornicova¹,

Bar-Sela²

2019

Ann Transl Med

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“…found in their series of 124 patients; those who achieved gross-total resection had a median survival of 12.5 months and those who did not survived for a median of 4.2 months; however, this did not reach statistical significance. [ 38 ] Tendulkar et al . showed in their study of 271 patients; a median survival of 10.6 months following gross-total resection compared to 8.7 following subtotal resection; however, this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors following resection of intracranial metastases

Henderson¹,

Zafar²,

Bjornson³

et al. 2022

Surgical Neurology International

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Background: The aim of this study was to identify prognostic factors associated with resection of intracranial metastases. Methods: A retrospective case series including patients who underwent resection of cranial metastases from March 2014 to April 2021 at a single center. This identified 112 patients who underwent 124 resections. The median age was 65 years old (24–84) and the most frequent primary cancers were nonsmall cell lung cancer (56%), breast adenocarcinoma (13%), melanoma (6%), and colorectal adenocarcinoma (6%). Postoperative MRI with contrast was performed within 48 hours in 56% of patients and radiation treatment was administered in 41%. GraphPad Prism 9.2.0 was used for the survival analysis. Results: At the time of data collection, 23% were still alive with a median follow-up of 1070 days (68–2484). The 30- and 90-day, and 1- and 5-year overall survival rates were 93%, 83%, 35%, and 17%, respectively. The most common causes of death within 90 days were as follows: unknown (32%), systemic or intracranial disease progression (26%), and pneumonia (21%). Age and extent of neurosurgical resection were associated with overall survival (P < 0.05). Patients aged >70 had a median survival of 5.4 months compared with 9.7, 11.4, and 11.4 for patients <50, 50–59, and 60–69, respectively. Gross-total resection achieved an overall survival of 11.8 months whereas sub-total, debulking, and unclear extent of resection led to a median survival of 5.7, 7.0, and 9.0 months, respectively. Conclusion: Age and extent of resection are potential predictors of long-term survival.

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Surgery for brain metastases: An analysis of outcomes and factors affecting survival

Cited by 20 publications

References 24 publications

Management of brain metastasis. Surgical resection versus stereotactic radiotherapy: a meta-analysis

Management of brain metastasis. Surgical resection versus stereotactic radiotherapy: a meta-analysis

Do we have a “game changer” in treating patients with brain metastasis from renal cell carcinoma?

Prognostic factors following resection of intracranial metastases

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