The role of surgery for brain metastases from solid tumors

Area of Science:

• Neuro-oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Brain metastases represent a significant challenge in cancer care, necessitating multimodal treatment strategies.
• Current therapeutic approaches include surgery, stereotactic radiosurgery, radiotherapy, and chemotherapy, often in combination.
• Novel targeted therapies are increasingly integrated into treatment paradigms for brain metastases.

Purpose of the Study:

• To elucidate the primary goals of microsurgery for brain metastases, including diagnosis, debulking, local control, and survival.
• To evaluate the efficacy of complete surgical resection and stereotactic radiosurgery for brain metastases.
• To assess the necessity of whole brain radiotherapy (WBRT) following gross total resection in select patient populations.

Main Methods:

• Review of established treatment modalities for brain metastases.
• Analysis of surgical goals: tissue sampling, space-occupying effect relief, local tumor control, and survival prolongation.
• Comparison of stereotactic radiosurgery efficacy for specific tumor sizes and locations.
• Evaluation of adjuvant radiotherapy strategies post-resection, including WBRT versus focal irradiation.

Main Results:

• Complete surgical resection is associated with improved local tumor control and potentially enhanced overall survival.
• Stereotactic radiosurgery is a viable and effective alternative for metastases up to 3 cm, particularly in eloquent or deep-seated areas.
• Gross total resection, confirmed by postoperative MRI, may not require combination with WBRT in patients with good performance status and controlled systemic disease.
• Focal irradiation or radiosurgery to the resection cavity or tumor remnant is a preferred alternative to WBRT in cases of incomplete resection.

Conclusions:

• Multimodal therapy, including surgery, stereotactic radiosurgery, and chemotherapy, forms the cornerstone of brain metastases management.
• Surgical resection and stereotactic radiosurgery offer significant benefits for local tumor control and survival.
• The role of WBRT is evolving, with focal irradiation being a potentially superior strategy in specific post-resection scenarios.