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Published on: June 7, 2020
Evaluating the Impact of Index Metastasis Resection in Patients with Multiple Brain Metastases
Maria Goldberg1, Luisa Mona Kraus1, Cvetina Vatcheva1
1Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, 81765 Munich, Germany.
Background:
The impact of surgical resection on the survival and functional outcomes of patients with multiple brain metastases remains a critical question in neuro-oncology.
Methods:
This retrospective study involved 160 patients who underwent surgical resection of brain metastases from 2017 to 2020. Patients were classified by the number of metastases-single, oligometastatic, or multiple-and whether complete removal of the main symptomatic lesion was achieved. Outcomes such as survival rates, complications, and functional status were assessed.
Results:
Among the patients, 48.1% had a single metastasis, 21.9% were oligometastatic, and 30% had multiple metastases. Survival did not differ by number of metastases when the main lesion was completely resected and remaining lesions were radiated (p = 0.6172). Complete resection increased mean survival to 15.74 months compared with 4.5 months without it. Additionally, patients who underwent complete resection experienced fewer seizures (16.2% vs. 32.6%, p = 0.019), implying a lower seizure risk. Functional independence was maintained post-surgery.
Conclusions:
While multiple brain metastases are generally associated with poor outcomes, a trend toward longer survival was observed after complete resection of the index metastasis, though this was not statistically significant. Radiation of residual lesions remains important to support prognosis. Reducing the tumor volume is key to lowering seizure risk. This study supports the role of aggressive surgical interventions, paired with radiation, to potentially enhance outcomes in patients with multiple brain metastases.
Insights
Complete resection of the main brain metastasis may improve survival and reduce seizure risk, even with multiple metastases. Aggressive surgery combined with radiation therapy is recommended for better patient outcomes.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Oncology
Background:
- The management of multiple brain metastases presents a significant challenge in neuro-oncology.
- Surgical resection's impact on survival and functional outcomes for these patients is a critical area of investigation.
Purpose of the Study:
- To evaluate the effect of surgical resection on survival and functional outcomes in patients with single, oligometastatic, and multiple brain metastases.
- To determine if complete resection of the primary symptomatic lesion impacts outcomes.
Main Methods:
- Retrospective analysis of 160 patients who underwent surgical resection of brain metastases between 2017 and 2020.
- Classification of patients based on the number of metastases (single, oligometastatic, multiple).
- Assessment of survival rates, complications (including seizures), and functional status post-surgery.
Main Results:
- Complete resection of the main lesion significantly increased mean survival from 4.5 to 15.74 months.
- Patients undergoing complete resection had a lower incidence of seizures (16.2% vs. 32.6%).
- Functional independence was generally maintained post-operatively, regardless of metastasis number when the main lesion was fully removed.
Conclusions:
- Complete resection of the index metastasis, combined with radiation of residual lesions, shows a trend towards improved survival in patients with multiple brain metastases.
- Surgical debulking is crucial for reducing seizure risk.
- Aggressive surgical intervention coupled with adjuvant radiation may enhance outcomes for patients with multiple brain metastases.
