Abstract
Although surgery is traditionally performed for patients with a single brain metastasis, an increasing number of patients with multiple brain metastases may also be treated surgically. The objective of the study was to analyze postoperative survival results and the clinical factors affecting these results. The records of the patients who underwent surgical resection of 2 or more lesions between January 2005 and January 2010 were retrospectively reviewed. Survival was calculated from the date of surgery to the last follow-up evaluation or death, and different clinical factors were analyzed in regard to patient survival. In total, 36 patients underwent one or more craniotomies. The survival of the total group ranged from 16 days to 37.5 months (mean, 29 months). There were 4 deaths within 30 days. When divided into Radiation Therapy Oncology Group RPA classes, the survival time was 11.75, 8.58, and 5.31 months for classes 1, 2, and 3, respectively. Regarding an impact on the survival, a significant association with a favorable outcome was found for the following factors: the number of brain metastases (2-3 vs. 4-6, P=0.046), RPA classes (1 vs. 2 or 3, P=0.0192), and extent of metastasis resection (all vs. partial, P=0.018). Well-selected patients with multiple brain metastases appear to benefit from surgery compared with historical controls of patients treated with whole-brain radiotherapy alone.
Highlights
With an increase in the early detection of primary tumors and longer survival in patients with cancer, the incidence of brain metastases is rising
Regarding an impact on the survival, a significant association with a favorable outcome was found for the following factors: the number of brain metastases (2–3 vs. 4–6, P=0.046), recursive partitioning analysis (RPA) classes (1 vs. 2 or 3, P=0.0192), and extent of metastasis resection
Well-selected patients with multiple brain metastases appear to benefit from surgery compared with historical controls of patients treated with whole-brain radiotherapy alone
Summary
With an increase in the early detection of primary tumors and longer survival in patients with cancer, the incidence of brain metastases is rising. The most common primary sites of brain metastases are lung (17%), renal cell (10.5%), and breast (5.2%) cancer and melanoma (8%) [1]. Melanoma has the highest frequency of presentation with multiple metastases of all primary tumors [2]. Prognosis for patients with brain metastases is generally poor (median survival, 2.3–7.1 months), and therapy is aimed at providing optimum quality of life while reducing the rates of tumor relapses [3]. Whole-brain radiotherapy (WBRT) has been the gold standard treatment for patients with cranial metastases [4]. Patients with multiple brain metastases were considered good candidates for aggressive surgical treatment because it was thought
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