Reduced local recurrence of a single brain metastasis through microscopic total resection

Clinical article

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Object

The goal of this study was to evaluate the therapeutic impact of the resection of metastatic brain tumor cells infiltrating adjacent brain parenchyma.

Methods

Between July 2001 and February 2007, 94 patients (67 males and 27 females, with a mean age of 55.0 ±12.0 years) underwent resection of a single brain metastasis, followed by systemic chemotherapy with or without radiotherapy. In 43 patients with tumors located in noneloquent areas, the authors performed microscopic total resections (MTRs) that included tumor cells infiltrating adjacent brain parenchyma, and they pathologically confirmed during surgery that the resection margins were free of tumor cells (MTR group). In 51 patients with lesions in eloquent locations, gross-total resections (GTRs) were performed without the removal of neighboring brain parenchyma (GTR group). The 2 groups were then compared for local recurrence and survival.

Results

The MTR group had better local control of the tumor than did the GTR group; 10 (23.3%) of 43 patients in the MTR group and 22 (43.1%) of 51 patients in the GTR group had a local recurrence (p = 0.04). The median time to tumor progression in the MTR group could not be calculated using the Kaplan-Meier method, whereas it was 11.4 months in the GTR group. The 1- and 2-year respective local recurrence rates were 29.1 and 29.1% in the MTR group and 58.6 and 63.2% in the GTR group (p = 0.01). Multivariate analysis showed that the MTR procedure was associated with a decreased risk of local recurrence (p = 0.003). A Cox regression analysis revealed that the hazard ratio for a local recurrence in the MTR group versus the GTR group was 3.14 (95% CI 1.47–6.72, p = 0.003). There was no significant difference in the local recurrence rate between the MTR group without radiotherapy (10 [30.3%] of 33) and the GTR group with postoperative radiotherapy (5 [26.3%] of 19).

Conclusions

The results in this study suggest that MTRs including tumor cells infiltrating adjacent brain parenchyma for a single brain metastasis provide better local tumor control.

Abbreviations used in this paper: GTR = gross-total resection; HR = hazard ratio; KPS = Karnofsky Performance Scale; MTR = microscopic total resection; NSCLC = non–small cell lung cancer; RPA = recursive partitioning analysis; TTP = time to progression.

Article Information

Address correspondence to: Seung-Hoon Lee, M.D., Ph.D., NeuroOncology Clinic, National Cancer Center, 809 Madu-1 dong, Ilsandong-gu, Goyang, Gyonggi 411-769, Republic of Korea. email: nslsh@ncc.re.kr.

Current address for Dr. Kim: Sungkyunkwan University, Samsung Medical Center, Masan Samsung Hospital, Masan, Republic of Korea.

Please include this information when citing this paper: published online December 12, 2008; DOI: 10.3171/2008.8.JNS08448.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Schematic illustrating the extent of resection achieved with one of 2 procedures. In an MTR, the extent of resection included infiltrated brain parenchyma surrounding tumor. In a GTR, only a metastasectomy was done.

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    Graph showing recurrence-free survival, according to the extent of surgical removal.

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    Graph revealing recurrence-free survival, according to postoperative radiotherapy.

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    Graph demonstrating recurrence-free survival, according to the extent of surgical removal and radiotherapy.

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