Abstract
Brain metastasis is the most common type of intracranial tumor. The contemporary management of brain metastasis is a challenging issue and traditionally has carried a poor prognosis as these lesions typically occur in the setting of advanced cancer. However, improvement in systemic therapy, advances in radiation techniques and multimodal therapy tailored to the individual patient, has given hope to this patient population. Surgical resection has a well-established role in the management of brain metastasis. Here we discuss the evolving role of surgery in the treatment of this diverse patient population.
Highlights
Brain metastases represent the most common brain tumors in adults in the United States and outnumber primary brain tumors 5:1 [1, 2]
The first was conducted by Patchell and colleagues, who randomized patients with a single brain metastasis to receive tumor resection followed by whole-brain radiation therapy (WBRT) (n = 25) versus WBRT alone (n = 23) [11]
Younger patients (
Summary
Brain metastases represent the most common brain tumors in adults in the United States and outnumber primary brain tumors 5:1 [1, 2]. In addition to the clinical benefits, surgical resection provides a known survival advantage in the setting of single metastasis. The first was conducted by Patchell and colleagues, who randomized patients with a single brain metastasis to receive tumor resection followed by whole-brain radiation therapy (WBRT) (n = 25) versus WBRT alone (n = 23) [11]. The authors found that patients in the surgical resection group survived significantly longer than patients treated with WBRT alone (median survival of 40 weeks versus 15 weeks, respectively). A second prospective randomized study by Vecht et al compared combination surgical resection plus radiation versus radiation alone in patients with a single brain lesion [12]. Patients receiving surgery + SRS demonstrated significantly longer survival compared with those receiving SRS alone with a median survival of 15.2 months versus 10 months (p < 0.01) respectively. This study highlights the critical role of surgery even with the availability of SRS
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