Complete resection of brain metastases - when does it matter?

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• The efficacy of gross total resection (GTR) for brain metastases (BM) remains a subject of debate.
• Optimal surgical strategies for BM aim to improve patient survival and quality of life.

Purpose of the Study:

• To investigate the specific conditions under which GTR significantly improves outcomes in patients with BM.
• To identify patient subgroups who benefit most from complete surgical resection of brain metastases.

Main Methods:

• Retrospective analysis of 539 patients with BM who underwent surgical resection.
• Tumor size assessed by contrast-enhancing areas on pre-operative MRI; GTR confirmed by post-operative MRI.
• Overall survival (OS) and progression-free survival (PFS) were the primary outcome measures.

Main Results:

• GTR was achieved in 82.8% of patients but did not significantly improve OS or PFS in the overall cohort.
• A significant survival benefit of GTR was observed in patients with solitary BM (HR: 0.39, p=0.0006).
• GTR benefit was also associated with younger age (<65 years), controlled systemic disease, focal radiotherapy, and postsurgical systemic treatment.

Conclusions:

• GTR is particularly valuable for patients with solitary BM and controlled systemic disease.
• Patient age, specific treatment regimens (radiotherapy, systemic therapy), and disease control status influence the benefit of GTR.
• Multivariate analysis confirmed that solitary BM and controlled disease status are key factors modulating GTR's impact.