Surgical treatment of metastatic brain tumors

Abstract

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.

Surgery for metastatic melanoma

“…Melanoma and small cell lung cancer are two of the most common tumors metastasizing to the brain. Twenty-five percent of cerebral metastases are superficial, occurring at the cortical-white junction interface, 25 to 40% percent of patients demonstrate solitary lesions, and the remainder have widely disseminated disease [4,34,35]. Up to half of metastatic brain lesions due to melanoma will bleed in either a subarachnoid or an intracerebral location.…”

“…Initial emergent treatment involves a short-term corticosteroid course to reduce edema surrounding the tumor while further workup is performed. Neurosurgery is a well-established treatment as the only possible chance for cure or long-term survival [34]-it can be offered to 5 to 10% of patients with brain metastases. Factors affecting long-term survival include isolated brain metastases treated with surgery or combined with radiotherapy, long-term diseasefree survival, absence of extracranial disease, and only mild symptoms at craniotomy [9,34,36].…”

MRI-Guided Laser Interstitial Thermal Therapy in Neuro-Oncology: A Review of Its Current Clinical Applications

“…Standard treatment modalities for metastases are surgery, radiotherapy, and/or stereotactic radiosurgery [76,77,78,79,80]. A summary of the various studies reporting the use of LITT for brain metastases and radiation necrosis is given in table 2.…”

Current Treatment Strategies in Brain Metastases

“…These data were confirmed by Arbit et al [66] when evaluating 109 patients with recurrent brain metastases of NSCLC. Sawaya et al [37] stated that whenever possible surgery should remain the treatment of choice, even in recurrent brain metastases. Wong et al [67] reported on 86 patients who were reirradiated for progressive brain metastases.…”

“…Radiotherapy can be preserved for recurrent tumor growth. Several investigators evaluated the efficacy of WBRT in addition to surgery versus WBRT alone [5,[14][15][16][36][37][38][39]. To date, the overall results of surgical treatment strategies plus adjuvant WBRT indicate that WBRT alone as treatment is inferior to the combined treatment [5,14].…”