Survival Then and Now in Patients With Surgically Resected Brain Metastasis: Major Improvement in Cases With...

The aim of this study was to analyze the survival outcomes in different time periods (recent, 2016-2024; earlier, 2007-2015; historical, before 2007) for patients with brain metastasis managed with surgical resection and postoperative radiotherapy. Major changes in systemic therapy over time were hypothesized to translate into better survival.

A retrospective analysis was performed that included 174 patients, largely with single brain metastasis and Karnofsky performance status (KPS) 80-100. Uni- and multivariate analyses of actuarial overall survival were performed.

Three significant prognostic factors for survival emerged: KPS, primary tumor control, and administration of systemic therapy after treatment of brain metastasis. In all patients, and also those who received systemic therapy after treatment for brain metastasis, survival remained similar (median of 16 months) for all three time periods (recent, earlier, historical). In patients with controlled primary tumor, survival increased from 17.5 (historical) to 35.8 months, p=0.01.

Patients with resected and postoperatively irradiated brain metastasis benefited from additional systemic therapy. Only one subgroup experienced major survival prolongation in more recent years: those with controlled primary tumor. Therefore, efforts to optimize primary tumor control, such as surgery and radical radiotherapy, may play an important role in multimodal treatment paradigms.