The results of resection after stereotactic radiosurgery for brain metastases

Clinical article

Hideyuki Kano M.D., Ph.D.1,3, Douglas Kondziolka M.D., F.R.C.S.C.1,3, Oscar Zorro M.D.1,3, Javier Lobato-Polo M.D.1,3, John C. Flickinger M.D.2,3, and L. Dade Lunsford M.D.1,3
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  • 1 Departments of Neurological Surgery,
  • | 2 Radiation Oncology, and the
  • | 3 Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Object

Radiosurgery for brain metastasis fails in some patients, who require further surgical care. In this paper the authors' goal was to evaluate prognostic factors that correlate with the survival of patients who require a resection of a brain metastasis after stereotactic radiosurgery (SRS).

Methods

During the last 14 years when surgical navigation systems were routinely available, the authors identified 58 patients who required resection for various brain metastases after SRS. The median patient age was 54 years. Prior adjuvant treatment included whole-brain radiation therapy alone (17 patients), chemotherapy alone (9 patients), both radiotherapy and chemotherapy (10 patients), and prior resection before SRS (8 patients). The median target volumes at the time of SRS and resection were 7.7 cm3 (range 0.5–24.9 cm3) and 15.5 cm3 (range 1.3–81.2 cm3), respectively.

Results

At a median follow-up of 7.6 months, 8 patients (14%) were living and 50 patients (86%) had died. The survival after surgical removal was 65, 30, and 16% at 6, 12, and 24 months, respectively (median survival after resection 7.7 months). The local tumor control rate after resection was 71, 62, and 43% at 6, 12, and 24 months, respectively. A univariate analysis revealed that patient preoperative recursive partitioning analysis classification, Karnofsky Performance Scale status, systemic disease status, and the interval between SRS and resection were factors associated with patient survival. The mortality and morbidity rates of resection were 1.7 and 6.9%, respectively.

Conclusions

In patients with symptomatic mass effect after radiosurgery, resection may be warranted. Patients who had delayed local progression after SRS (> 3 months) had the best outcomes after resection.

Abbreviations used in this paper:

KPS = Karnofsky Performance Scale; NSCLC = non–small cell lung cancer; RPA = recursive partitioning analysis; SCLC = small cell lung cancer; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy.

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