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Postoperative absence of residual intracranial tumor volume is associated with improved survival and intracranial

Jacopo Bellomo1, Meltem Gönel1, Jonathan Sutter2

  • 1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland.

Journal of Neuro-Oncology
|December 22, 2025
PubMed
Summary

Complete surgical removal of brain metastases in non-small cell lung cancer patients improves survival. Achieving gross-total resection (GTR) is key, regardless of residual tumor volume, offering better outcomes.

Keywords:
Brain metastasisExtent of resectionImmunotherapyLung cancerOverall survivalProgression-free survivalResidual tumorTargeted therapy

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Area of Science:

  • Neurosurgery
  • Oncology
  • Radiotherapy

Background:

  • Brain metastases (BM) from non-small cell lung cancer (NSCLC) present a poor prognosis.
  • The role of surgical tumor removal in NSCLC BM management is unclear with modern therapies.

Purpose of the Study:

  • To evaluate the prognostic significance of intracranial tumor load reduction in NSCLC BM.
  • To determine if gross-total resection (GTR) impacts survival and intracranial progression-free survival (iPFS).

Main Methods:

  • Retrospective analysis of 285 NSCLC patients undergoing BM resection.
  • Volumetric assessment using pre- and postoperative MRI to define GTR.
  • Multivariable Cox regression adjusted for clinical factors and treatments.

Main Results:

  • Gross-total resection (GTR) was achieved in 34% of patients.
  • GTR was independently associated with improved overall survival (OS) and iPFS.
  • Postoperative residual volume did not consistently correlate with outcomes.

Conclusions:

  • Complete tumor resection (GTR) is crucial for improved survival and intracranial control in NSCLC BM.
  • GTR is clinically relevant for selected patients, aiding surgical decisions.
  • Further research is needed for multifocal but resectable intracranial disease.