Summary
The role of surgical resection for brain metastases is evolving. The most common primary for brain metastases is lung; in the US in 1992, for example, there were nearly 40,000 deaths with symptomatic brain metastases from lung cancer.
We reviewed a series of 25 consecutive patients with non small cell lung cancer (NSCLC) undergoing open resection of one or moresymptomatic brain metastases to consider the role of open resection. Twenty-three of the 28 resected lesions were 3 cm or greater in diameter; 19 were solid and nine cystic. Surgical adjuncts included (where indicated): stereotactic biopsy, cyst drainage, and craniotomy; intra-operative ultrasound; and intra-operative evoked potential mapping of the sensorimotor area. Six patients underwent thoracotomy for resection of the lung primary (in all but one case, prior to craniotomy). Except for two patients who had had whole brain radiation therapy (WBXRT) prior to referral to Neurosurgery, all patients underwent WBXRT (30 to 60 Gy) postoperatively.
The mean survival from date of craniotomy was 13.1 months, with two patients still alive at ten and seventeen months post-cra-niotomy. Survival comparisons which were significantly different included (1) lung surgery versus no lung surgery (25.7 months versus 9.1 months, P < 0.001), and (2) metachronous presentation of the lung primary and brain metastasis versus synchronous presentation (17.6 months versus 9.5 months, ≈). Survival comparisons which werenot significantly different included single versus multiple metastases, complete versus incomplete resection, adeno-carcinoma versus large or squamous or cell histology, supratentorial versus infratentorial location, solid versus cystic metastasis, and age ≤ 60 years versus > 60 years.
These results, when compared with the literature on brain metastases, suggest that aggressive resection of symptomatic metastases from lung cancer (even if multiple) can improve functional survival over conservative management, and that small, asymptomatic lesions are well-controlled by WBXRT. They also confirm the previous finding that surgical treatment of both the lung primary and the brain metastases may afford the greatest period of functional survival for these patients.
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References
Adler JR, Cox RS, Kaplan I, Martin, DP (1992) Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76: 444–449
Andrews RJ, Kirby RP (1989) Improved survival with surgical treatment of both primary lung cancer and brain metastases. Lancet: 1460–1461
Andrews RJ, Woods DL (1990) Intraoperative mapping of somatosensory cortex: comparison of median nerve and selective digital stimulation. Proceedings of the 40th Annual Meeting of the Congress of Neurological Surgeons, Los Angeles, CA, p 136
Arbit E, Wronski M, Galicich JH (1994) Surgical resection of brain metastases in 670 patients: the Memorial Sloan-Kettering cancer experience 1972–1992. J Neurosurg 80: 386A
Bindal RK, Sawaya R, Leavens ME, Lee JJ (1993) Surgical treatment of multiple brain metastases. J Neurosurg 79: 210–216
Boring CC, Squires TS, Tong T (1993) Cancer statistics, 1993. CA Cancer J Clin 43: 7–26
Burt M, Wronski M, Arbit E, Galicich JH (1992) Resection of brain metastases from non-small-cell lung carcinoma: results of therapy. J Thprac Cardiovasc Surg 103: 399–441
Catinella FP, Kittle CF, Faber P, Milloy FJ, Warren WH, Von Roenn KA (1989) Surgical treatment of primary lung cancer and solitary intracranial metastasis. Chest 95: 972–975
Coffey RJ, Flickinger JC, Bissonette DJ, Lunsford LD (1991) Radiosurgery for solitary brain metastases using the cobalt-60 gamma unit: methods and results in 24 patients. Int J Radiat Oncol Biol Phys 20: 1287–1295
Engenhart R, Kimmig BN, Hover KH, Kaick G, Wannenmacher M (1993) Long-term follow-up for brain metastases treated by percutaneous Stereotactic single high-dose irradiation. Cancer 71: 1353–1361
Flickinger JC, Kondziolka D, Lunsford LD (1994) A multi-institutional experience with Stereotactic radiosurgery for solitary brain metastases. Int J Radiat Oncol Biol Phys 28: 797–802
Fried BM, Buckley RC (1930) Primary carcinoma of the lungs. IV. Intracranial metastases. Arch Path 9: 483–527
Gotoh O, Asano T, Koide T, Kakakura K (1985) Ischemic brain edema following occlusion of the middle cerebral artery in the rat. I. The time courses of the brain water, sodium and potassium contents and blood-brain barrier permeability to125I-albumin. Stroke 16: 101–109
Hazuka MB, Burleson WD, Stroud DN, Leonard CE, Lillehei KO, Kinzie JJ (1993) Multiple brain metastases are associated with poor survival in patients treated with surgery and radiotherapy. J Clin Oncol 11: 369–373
Kelly PJ, Kail BA, Goerss SJ (1988) Results of computed tomography-based computer-assisted Stereotactic resection of metastic intracranial tumors. Neurosurgery 22: 7–17
Loeffler JS, Kooy HM, Wen PY, Fine HA, Cheng CW, Mannarino EG, Tsai JS, Alexander E (1990) The treatment of recurrent brain metastases with Stereotactic radiosurgery. J Clin Oncol 8: 576–582
Macchiarini P, Buonaguidi R, Hardin M, Mussi A, Angeletti CA (1991) Results and prognostic factors of surgery in the management of non-small cell lung cancer with solitary brain metastasis. Cancer 68: 300–304
Mandell L, Hilaris B, Sullivan M, Sundaresan N, Nori D, Kim JH, Martini N, Fuks Z (1986) The treatment of single brain metastasis from non-oat cell lung carcinoma. Cancer 58: 641–649
Meneses MS, Creissard P, Lerebours-Pigeonniere G, Nouvet G (1987) Surgery for intracranial metastases of bronchial origin. Rev Pneumol Clin 43: 219–223
Nakagawa H, Miyawaki Y, Fujita T, Kubo S, Tokiyoshi K, Tsuruzono K, Kodama K, Hiagshiyama M, Doi O, Hayakawa T (1994) Surgical treatment of brain metastases of lung cancer: retrospective analysis of 89 cases. J Neurol Neurosurg Psychiatry 57: 950–956
Noordijk EM, Vecht CJ, Haaxma-Reiche H, Padberg GW, Voormolen JHC, Hoekstra FH, Tans JTJ, Lambooij N, Metsaars JAL, Wattendorff AR, Brand R, Hermans J (1994) The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29: 711–717
Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, MacDonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322: 494–500
Read RC, Boop WC, Yoder G, Schaefer R (1989) Management of nonsmall cell lung carcinoma with solitary brain metastasis. J Thorac Cardiovasc Surg 98: 884–891
Rizzi A, Tondini M, Rocco G, Rossi G, Robustellini M, Radaelli F, Della Pona C (1990) Lung cancer with single brain metastasis: therapeutic options. Tumori 76: 579–581
Smalley SR, Laws ER, O'Fallon JR, Shaw EG, Schray MF (1992) Resection for solitary brain metastasis. J Neurosurg 77: 531–540
Sundaresan N, Galicich JH (1985) Surgical treatment of brain metastases: clinical and computerized tomography evaluation of the results of treatment. Cancer 55: 1382–1388
Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JHC, Hoekstra FH, Tans JTJ, Lambooij N, Metsaars JAL, Wattendorff AR, Brand R, Hermans J (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33: 583–590
Wright DC, Delany TF, Buckner JC (1993) Treatment of metastatic cancer. In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology, 4th Ed. Lippincott, Philadelphia, pp 2170–2186
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Andrews, R.J., Gluck, D.S. & Konchingeri, R.H. Surgical resection of brain metastases from lung cancer. Acta neurochir 138, 382–389 (1996). https://doi.org/10.1007/BF01420299
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DOI: https://doi.org/10.1007/BF01420299