Giancarlo D'Andrea1, Lucia Palombi2, Giuseppe Minniti3, Alessandro Pesce4, Paolo Marchetti2. 1. Department of Neurosurgery, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy. Electronic address: gdandrea2002@yahoo.it. 2. Department of Oncology, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy. 3. Department of Radiation Oncology, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy. 4. Department of Neurosurgery, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy; Sant'Andrea Hospital, Rome, Italy.
Abstract
BACKGROUND: Brain metastases occur in 10%-40% of patients with cancer and are more common than primary brain tumors (30%-40%); their incidence is growing because of improvements in control of systemic disease, better radiologic detection, and prolonged survival. Modern treatment of brain metastases has dramatically changed the expected prognosis. Traditionally, the prognosis has been considered very poor, and patients were referred to palliative treatment because of their terminal stage; however, new prognostic indexes have been proposed to evaluate these patients. The aim of our study was to determine the long-term effect of surgery on overall survival (OS) in patients with brain metastases from dissimilar primary tumors and to identify prognostic variables associated with prolonged survival. METHODS: We retrospectively reviewed a consecutive series of patients who underwent surgery between January 2010 and October 2014 for cerebral metastases from lung, kidney, breast, and gastrointestinal cancers and melanoma. Variables included age; sex; histology; location of lesions; and specific treatments patients had undergone including chemotherapy, radiotherapy, and surgery, individually or combined. RESULTS: No patients deteriorated after surgery. At discharge, 19 patients (26.76%) had an unchanged postoperative neurologic examination, whereas 52 patients (73.23%) showed improvement (χ2 = 34.84, P < 0.0001). Expected OS, considering all tumor subtypes, was 372.24 months; the patients in our series had an OS of 787 months, more than twice the expected OS; specifically, average expected survival of each patient was 5.24 months, whereas actual survival was 11.08 months (P = 0.000008). CONCLUSIONS: Surgery is a safe and effective procedure for cerebral metastases and should not be considered an aggressive treatment in such disease. In our series, 55% of patients had a survival >6 months and a significant improvement in terms of actual versus expected survival. Surgical resection should be considered the primary option for patients with brain metastases.
BACKGROUND:Brain metastases occur in 10%-40% of patients with cancer and are more common than primary brain tumors (30%-40%); their incidence is growing because of improvements in control of systemic disease, better radiologic detection, and prolonged survival. Modern treatment of brain metastases has dramatically changed the expected prognosis. Traditionally, the prognosis has been considered very poor, and patients were referred to palliative treatment because of their terminal stage; however, new prognostic indexes have been proposed to evaluate these patients. The aim of our study was to determine the long-term effect of surgery on overall survival (OS) in patients with brain metastases from dissimilar primary tumors and to identify prognostic variables associated with prolonged survival. METHODS: We retrospectively reviewed a consecutive series of patients who underwent surgery between January 2010 and October 2014 for cerebral metastases from lung, kidney, breast, and gastrointestinal cancers and melanoma. Variables included age; sex; histology; location of lesions; and specific treatments patients had undergone including chemotherapy, radiotherapy, and surgery, individually or combined. RESULTS: No patients deteriorated after surgery. At discharge, 19 patients (26.76%) had an unchanged postoperative neurologic examination, whereas 52 patients (73.23%) showed improvement (χ2 = 34.84, P < 0.0001). Expected OS, considering all tumor subtypes, was 372.24 months; the patients in our series had an OS of 787 months, more than twice the expected OS; specifically, average expected survival of each patient was 5.24 months, whereas actual survival was 11.08 months (P = 0.000008). CONCLUSIONS: Surgery is a safe and effective procedure for cerebral metastases and should not be considered an aggressive treatment in such disease. In our series, 55% of patients had a survival >6 months and a significant improvement in terms of actual versus expected survival. Surgical resection should be considered the primary option for patients with brain metastases.
Authors: Eric W Sankey; Vadim Tsvankin; Matthew M Grabowski; Gautam Nayar; Kristen A Batich; Aida Risman; Cosette D Champion; April K S Salama; C Rory Goodwin; Peter E Fecci Journal: Cancer Med Date: 2019-09-30 Impact factor: 4.452
Authors: Josephine Jung; Jignesh Tailor; Emma Dalton; Laurence J Glancz; Joy Roach; Rasheed Zakaria; Simon Lammy; Aswin Chari; Karol P Budohoski; Laurent J Livermore; Kenny Yu; Michael D Jenkinson; Paul M Brennan; Lucy Brazil; Catey Bunce; Elli Bourmpaki; Keyoumars Ashkan; Francesco Vergani Journal: Neurooncol Pract Date: 2019-12-06
Authors: Joonas Toivonen; Mikko Björkqvist; Heikki Minn; Pekka K Vallittu; Jami Rekola Journal: J Appl Clin Med Phys Date: 2019-11-29 Impact factor: 2.102