[Metastases to the brain--prognosis and surgical indications]

The prognosis of the patients with metastases to the brain is very poor. Based on the data obtained from the Brain Tumor Registry in Japan, relative survival rate curve of the cases with metastatic brain tumors is extremely similar to that of the cases with glioblastoma multiforme which is the most malignant primary brain tumor. Data obtained from the Department of Neurosurgery of Osaka University Medical School, the Center for Adult Diseases, Osaka demonstrated that the brain lesions were the direct causes of death only in 26% of the cancer patients with brain metastases. The result might have indicated that brain metastasis itself could be more controllable than the other lesions of systemic in most of the cases. The indications for surgical treatment of metastatic brain tumors are, in general, as follows; (1) the primary cancer is cured or to be cured, (2) no metastasis to other organs, (3) the brain metastasis is single, solitary and surgically accessible, and (4) the general condition is good enough. But recent advancement in the diagnosis, surgery and patient care are going to extend the indications for surgical treatment. Surgical mortality becomes less than a few percent. The changes of performance status by surgery were investigated in the patients treated in Department of Neurosurgery, Osaka University Medical School and the Center for Adult Diseases, Osaka. Improvement of the performance status after surgery was obtained in 57.8%, stationary in 30.5%, and worsening only in 11.8%.