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Surgical treatment of metastatic brain tumors

  • Special Section: Joint Section on Tumors
  • Published:
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Abstract

The most common structural neurologic complication of systemic cancer is brain metastasis. For the most part, treatment is palliative because the majority of patients (≥ 50%) have uncontrollable systemic cancer. However, for patients in whom the only metastasis is to the brain, death is more likely to result from the metastasis than from the systemic disease; hence, treatment of the metastasis is vitally important. Although radiotherapy is generally considered the preferred treatment, surgical removal of the mass, whether single or multiple, may be the most effective palliation, especially for tumors from radio-resistant diseases such as melanoma, kidney and colon cancer. We review the information regarding therapeutic decision-making; advances in surgical procedures, namely computer-assisted stereotactic and/or intraoperative ultrasound and mapping techniques; the efficacy of postoperative WBRT; complications and benefits of surgery; our experience with reoperation for recurrent metastatic brain tumors, the results of which indicate that reoperation for recurrent brain metastasis can prolong survival and improve quality of life for most individuals; our results comparing surgery versus radiosurgery, which show that patients who undergo surgical treatment live longer and have better tumor control than those treated with radiosurgery; and the patient's prognosis. The conclusion is that surgery should remain the treatment of choice whenever possible.

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References

  1. Patchell RA, Posner JB: Neurologic complications of systemic cancer. Neurologic Clinics 3: 729, 1985

    Google Scholar 

  2. Galicich J, Arbit E: Metastatic brain tumors. p. 3204. In: Youmans J (ed) Neurological Surgery. 3rd ed. WB Saunders Company, Philadelphia, 1990

    Google Scholar 

  3. Boogerd W, Vos VW, Hart AAM, Baris G: Brain metastases in breast cancer; natural history, prognostic factors and outcome. J Neuro-Oncology 15: 165, 1993

    Google Scholar 

  4. Bucholz A: Kasuistischer Beitrag zur Kenntnis der Karzinome des Zentralnervensystmes. Monatsschr Psychiatr Neurol 4: 183, 1898

    Google Scholar 

  5. Brega K, Robinson WA, Winston K, Wittenberg W: Surgical treatment of brain metastases in malignant melanoma. Cancer 66: 2105, 1990

    Google Scholar 

  6. Cairncross JG, Kim J-H, Posner JB: Radiation therapy for brain metastases. Ann Neurol 7: 529, 1980

    Google Scholar 

  7. Galicich JH, Sundaresan N, Thaler HT Surgical treatment of single brain metastases. Evaluation of results by computerized tomography scanning. J Neurosurg 53: 63, 1980

    Google Scholar 

  8. Zimm S, Wampler GL, Stablein D, Hazra T, Young HF: Intracerebral metastases in solid-tumor patients. Natural history and results of treatment. Cancer 48: 384, 1981

    Google Scholar 

  9. Cushing H: Intercranial tumors. Charles C Thomas, Springfield ILL, 1932

    Google Scholar 

  10. Dandy WH: Surgery of the brain. WF Prior, Hagerstown, MD, 1945

    Google Scholar 

  11. Grant F: Concerning intracranial malignant metastases: their frequency and the value of surgery in their treatment. Annals Surg 84: 635, 1926

    Google Scholar 

  12. Galicich JH, Sundaresan N, Arbit E, Passe S: Surgical treatment of single brain metastases. Factors associated with survival. Cancer 45: 381, 1980

    Google Scholar 

  13. Patchell RA, Tibbs PA, Walsh JW et al.: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322: 494, 1990

    Google Scholar 

  14. Bindal R, Sawaya R, Leavens M et al.: Surgical treatment of multiple brain metastases. J Neurosurg 79: 210–216, 1993

    Google Scholar 

  15. Ferrara M, Bizzozzero L, Talamonti G, D'Angelo VA: Surgical treatment of 100 single brain metastases. J Neurosurg Sci 34: 303, 1990

    Google Scholar 

  16. Sundaresan N, Galicich JH: Surgical treatment of brain metastases: clinical and computerized tomography evaluation of the results of treatment. Cancer 55: 1382, 1985

    Google Scholar 

  17. Decker DA, Decker VL, Herskovic A, Cummings GD: Brain metastases in patients with renal cell carcinoma: Prognosis and treatment. J Clinic Oncol 3: 169, 1984

    Google Scholar 

  18. Moser RP, Johnson ML: Surgical management of brain metastases: How aggressive should we be? Oncology 3: 123, 1989

    Google Scholar 

  19. Landy H, Egnor M: Intraoperative ultrasonography and cortical mapping for removal of deep cerebral tumors. Southern Medical J 84: 1323, 1991

    Google Scholar 

  20. Sawaya R, Hammoud M, Ligon BL, Fuller GN: Gliomas: Intraoperative localization of tumor and margins. In: Berger MS, Wilson CB (eds) Textbook of Gliomas. Cambridge MA: W.B. Saunders (in press)

  21. Kelly PJ, Kall BA, Goerss SJ: Results of computed tomography-based computer-assisted stereotactic resection of metastatic intracranial tumors. Neurosurgery 22: 7, 1988

    Google Scholar 

  22. Lange O, Scheef, Haase K: Palliative radiochemotherapy with ifosfamide and BCNU for breast cancer patients with cerebral metastases: A 5-year experience. Cancer Chemother Pharmacol 26 (suppl): 78, 1990

    Google Scholar 

  23. Young B, Patchell RA: Surgery for a single brain metastasis. p. 473. In: Rengachary S, Wilkins R (eds) Neurosurgery Update. McGraw Hill, New York. 1990

    Google Scholar 

  24. Patchell RA: Brain metastases. Neurologic Clinics 9: 817, 1991

    Google Scholar 

  25. Tobler WD, Sawaya R, Tew JM Jr: Successful laser-assisted excision of a metastatic midbrain tumor. Neurosurgery 18: 795, 1986

    Google Scholar 

  26. Berger MS, Kincaid J, Ojemann GA, Lettich BA: Brain mapping techniques to maximize resection, safety and seizure control in children with brain tumours. Neurosurgery 25: 286, 1989

    Google Scholar 

  27. Ebeling U, Schmid UD, Ying H, Reulen JH: Safe surgery of lesions near the motor cortex using intra-operative mapping techniques: a report on 50 patients. Acta Neurochir 119: 23, 1992

    Google Scholar 

  28. Gregorie E, Goldring S: Localization of function in the excision of lesions from the sensorimotor region. J Neurosurg 61: 1047, 1984

    Google Scholar 

  29. Witzmann A, Beran H, Bohm-Jurkovic H, Löffler M: The prognostic value of somatosensory evoked potential monitoring and tumor data in supratentorial tumor removal. J Clin Monitoring 6: 75, 1990

    Google Scholar 

  30. Gambardella G, Santamaria LB, Toscano SG et al.: Brain metastases: surgical versus conservative treatment. J Neurosurg Sci 34: 309, 1990

    Google Scholar 

  31. DeAngelis L, Mandell L, Thaler H et al.: The role of postoperative radiotherapy after resection of single brain metastases. Neurosurgery 24: 798, 1989

    Google Scholar 

  32. Hagen N, Cirrincione C, Thaler H et al.: The role of radiation therapy following resection of single brain metastasis from melanoma. Neurology 40: 158, 1990

    Google Scholar 

  33. Smalley SR, Schray MF, Laws ER, O'Fallen JR: Adjuvant radiation therapy after surgical resection of solitary brain metastasis: association with pattern of failure and survival. Int J Radial Oncol Biol Phys 13: 1611, 1987

    Google Scholar 

  34. Haar F, Patterson H: Surgery for metastatic intracranial neoplasms. Cancer 30: 1231, 1972

    Google Scholar 

  35. Constantini S, Kornowski R, Pomeranz S, Rappaport ZH: Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumours. Acta Neurochirurgica 109: 93, 1991

    Google Scholar 

  36. Sawaya R: Postoperative venous thromboembolism and brain tumors: part I, clinical profile. N Neurooncol 14: 119, 1992

    Google Scholar 

  37. Patchell RA, Cirrincione C, Thaler HT et al.: Single brain metastases: Surgery plus radiation or radiation alone. Neurology 35: 447, 1986

    Google Scholar 

  38. Sundaresan N, Sachdev VP, DiGiacinto GV, Hughes JEO: Reoperation of brain metastases. J Clin Oncol 6: 1625, 1988

    Google Scholar 

  39. Kaye AH: Malignant brain tumors. p 49. In: Little J, Awad I (eds): Reoperatioe Neurosurgery. Williams & Wilkins, Baltimore, 1992

    Google Scholar 

  40. Sause WT, Crowley JJ, Morantz R, Rotman M et al.: Solitary brain metastasis: Results of an RTOG/SWOG protocol evaluation surgery + RT versus RT alone. Am J Clin Oncol 13: 427, 1990

    Google Scholar 

  41. Yardeni D, Reichenthal E, Zucker G et al.: Neurosurgical management of single brain metastasis. Surg Neurol 21: 377, 1984

    Google Scholar 

  42. Sundarasen N, Galicich JH: Surgical treatment of single brain metastases from non-small-cell lung cancer. Cancer Investigation 3: 107, 1985

    Google Scholar 

  43. Hankins JR, Miller JE, Salcman M et al.: Surgical management of lung cancer with solitary cerebral metastasis. Ann Thorac Surg 46: 24, 1988

    Google Scholar 

  44. Burt M, Wronski M, Arbit E, Galicich JA: Memorial sloankettering cancer center thoracic surgical staff: Resection of brain metastases from non-small cell lung carcinoma. J Thorac Cardiovasc Surg 103: 399, 1992

    Google Scholar 

  45. Fell DA, Leavens ME, McBride CM: Surgical versus nonsurgical management of metastatic melanoma of the brain. Neurosurgery 7: 238, 1980

    Google Scholar 

  46. Oredsson S, Ingvar C, Strömblad L-G, Jönsson P-E: Palliative surgery for brain metastases of malignant melanoma. Eur J Surg Oncology 16: 451, 1990

    Google Scholar 

  47. Badalament RA, Kreutzer E, Gluck RW et al.: Surgical treatment of brain metastases from renal cell carcinoma. Urology 36: 112, 1990

    Google Scholar 

  48. DiStefano A, Yap H-Y, Hortobagyi GN, Blumenschein GR: The natural history of breast cancer patients with brain metastases. Cancer 44: 1913–1918, 1979

    Google Scholar 

  49. Leavens ME, Moser RP, Obbens EAMT, Iwata KI: Surgical treatment of metastatic brain tumors. The Cancer Bulletin 38: 39, 1986

    Google Scholar 

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Authors and Affiliations

  1. Departments of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    Raymond Sawaya, B. Lee Ligon, Ajay K. Bindal & Rajesh K. Bindal

  2. Patient Studies, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    Kenneth R. Hess

Authors
  1. Raymond Sawaya
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  2. B. Lee Ligon
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  3. Ajay K. Bindal
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  4. Rajesh K. Bindal
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  5. Kenneth R. Hess
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Sawaya, R., Ligon, B.L., Bindal, A.K. et al. Surgical treatment of metastatic brain tumors. J Neuro-Oncol 27, 269–277 (1996). https://doi.org/10.1007/BF00165484

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