S Yoshida1, K Morii. 1. Department of Neurosurgery, Niigata Cancer Center Hospital, Niigata, Japan. brain@niigata-cc,niigata.niigata.jp
Abstract
BACKGROUND: To study the role of surgery for brain metastasis, we reviewed the records of 646 patients with brain metastasis. METHODS: 340 patients underwent operative removal of the brain metastasis. During the same period, another 306 patients were treated without surgery. Criteria for surgery included the anatomical site, size over 3 cm, and cystic changes. Outcome was assessed by survival and cause of death. TREATMENT: 340 patients received surgical treatment, and 210 of these received radiation therapy. Another 306 patients were treated without surgery; 250 patients received conventional radiation and 56 patients were treated radiosurgically using a gamma knife. The surgical group was younger and had a better Karnofsky score than those of the non-surgical group. The median survival periods in the surgical and non-surgical groups were 21.0 months and 8.0 months, respectively. In patients whose brain lesions were first found before the systemic disease, the 5 year survival rates for the surgical and non-surgical groups were 35.2% and 18.2%, respectively. Although neurological causes accounted for 33.0% of deaths in the non-surgical group, and 13.2% of deaths in the surgical group; this difference was not significant. CONCLUSIONS: This retrospective review showed that patients with a brain metastasis treated surgically survived longer with better tumor control. To determine if this summary reflects the critical prognostic imbalance of population, further studies with randomized comparison are required.
BACKGROUND: To study the role of surgery for brain metastasis, we reviewed the records of 646 patients with brain metastasis. METHODS: 340 patients underwent operative removal of the brain metastasis. During the same period, another 306 patients were treated without surgery. Criteria for surgery included the anatomical site, size over 3 cm, and cystic changes. Outcome was assessed by survival and cause of death. TREATMENT: 340 patients received surgical treatment, and 210 of these received radiation therapy. Another 306 patients were treated without surgery; 250 patients received conventional radiation and 56 patients were treated radiosurgically using a gamma knife. The surgical group was younger and had a better Karnofsky score than those of the non-surgical group. The median survival periods in the surgical and non-surgical groups were 21.0 months and 8.0 months, respectively. In patients whose brain lesions were first found before the systemic disease, the 5 year survival rates for the surgical and non-surgical groups were 35.2% and 18.2%, respectively. Although neurological causes accounted for 33.0% of deaths in the non-surgical group, and 13.2% of deaths in the surgical group; this difference was not significant. CONCLUSIONS: This retrospective review showed that patients with a brain metastasis treated surgically survived longer with better tumor control. To determine if this summary reflects the critical prognostic imbalance of population, further studies with randomized comparison are required.
Authors: Zjiwar H A Sadik; Patrick E J Hanssens; Jeroen B Verheul; Hilko Ardon; Suan Te Lie; Bram van der Pol; Guus N Beute; Ruth E M Fleischeuer; Sieger Leenstra Journal: Acta Neurochir (Wien) Date: 2020-04-14 Impact factor: 2.216