Abstract
BackgroundWhen treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection.MethodsBetween 2006 and 2011, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome.ResultsIn general, 8.7% of all patients postoperatively developed a new permanent paresis. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. This risk was even increased in perirolandic and rolandic lesions. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases’ infiltrative nature but might also be the result of our strict study protocol.ConclusionsSurgical resection is a safe treatment of brain metastases. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered.
Highlights
When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients
Routine follow-up included magnetic resonance imaging (MRI) scans every 3 months, depending on concurrent oncological therapy and tumor entity. We reviewed these follow-up MRI scans for recurrent metastases, since neurological status during follow-up was only considered during progression-free survival
Our results of an unexpected residual of about 20% lead into the same direction, but we have to keep in mind that the definition of residual tumor presented by residual contrast enhancement can result in considerable overestimation of real UR due to reactive postoperative changes
Summary
When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to identify risk factors for brain metastases resection. Modern treatment options for cerebral metastases limit surgical treatment to a subgroup of patients, which present with symptomatic lesions such as rolandic or cerebellar metastases Both radiosurgery and surgical resection have been shown to have comparable rates of local control. Surgical resection frequently treats metastases within or close to the motor cortex or corticospinal tract (CST)
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