Resection of brain metastases previously treated with stereotactic radiosurgery

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Object. To date, no report has been published on outcomes of patients undergoing resection for brain metastases who were previously treated with stereotactic radiosurgery (SRS). Consequently, the authors reviewed their institutional experience with this clinical scenario to assess the efficacy of surgical intervention.

Methods. Sixty-one patients (each harboring three or fewer brain lesions), who were treated at a single institution between June 1993 and August 2002 were identified. Patient charts and their neuroimaging and pathological reports were retrospectively reviewed to determine overall survival rates, surgical complications, and recurrence rates.

A univariate analysis revealed that patient preoperative recursive partitioning analysis (RPA) classification, primary disease status, preoperative Karnofsky Performance Scale score, type of focal treatment undergone for nonindex lesions, and major postoperative surgical complications were factors that significantly affected survival (p ≤ 0.05). In contrast, only the RPA class and focal (conventional surgery or SRS) treatment of nonindex lesions significantly (or nearly significantly) affected survival in the multivariate analysis. Major neurological complications occurred in only 2% of patients. The median time to distant recurrence after resection was 8.4 months; that to local recurrence was not reached. The overall median survival time was 11.1 months, with 25% of patients surviving 2 or more years. Conventional surgery facilitated tapering of steroid administration.

Conclusions. The complication, morbidity, survival, and recurrence rates are consistent with those seen after conventional surgery for recurrent brain metastases. Our results indicate that in selected patients with a favorable RPA class in whom nonindex lesions are treated with focal modalities, surgery can provide long-term control of SRS-treated lesions and positively affect overall survival.

Article Information

Address reprint requests to: Raymond Sawaya, M.D., Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 442, Houston, Texas 77030–4009. email: rsawaya@mdanderson.org.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graphs depicting the duration (in weeks) of steroid treatment from the time of conventional resection of the index lesion (Time 0). The duration of continuous treatment is shown both before (A) and after (B) conventional resection. Note that surgical resection facilitated tapering off of steroid use within 2 to 4 weeks.

  • View in gallery

    Graphs showing survival times after resection of a lesion that SRS previously failed to control. A: Kaplan—Meier estimate of overall survival for the 61 patients in the study. B: Survival of patients after being subgrouped according to the Radiation Therapy Oncology Group's RPA classification. Note the significant impact of RPA class on the overall patient survival time.

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