The Debatable Benefit of Gross-Total Resection of Brain Metastases in a Comprehensive Treatment Setting

Abstract

Background and Purpose: The value of gross-total surgical resection remains debatable in patients with brain metastases (BMs) as most patients succumb to systemic disease progression. In this study, we evaluated the impact of the extent of resection of singular/solitary BM on in-brain recurrence (iBR), focusing on local recurrence (LR) and overall survival (OS) in an interdisciplinary adjuvant treatment setting. Patients and Methods: In this monocentric retrospective analysis, we included patients receiving surgery of one BM and subsequent adjuvant treatment. A radiologist and a neurosurgeon determined in consensus the extent of resection based on magnetic resonance imaging. The OS was calculated using Kaplan-Meier estimates; prognostic factors for LR and OS were analysed by Log rank test and Cox proportional hazards. Results: We analyzed 197 patients. Gross-total resection was achieved in 123 (62.4%) patients. All patients were treated with adjuvant radiotherapy, and 130 (66.0%) received systemic treatment. Ninety-six (48.7%) patients showed iBR with an LR rate of 23.4%. LR was not significantly influenced by the extent of resection (p = 0.139) or any other parameter. The median OS after surgery was 18 (95%CI 12.5-23.5) months. In univariate analysis, the extent of resection did not influence OS (p = 0.6759), as opposed to adjuvant systemic treatment (p < 0.0001) and controlled systemic disease (p = 0.039). Systemic treatment and controlled disease status remained independent factors for OS (p < 0.0001 and p = 0.009, respectively). Conclusions: In this study, the extent of resection of BMs neither influenced the LR nor the OS of patients receiving interdisciplinary adjuvant treatment.

Keywords: brain metastasis; comprehensive oncological treatment; extent of resection; systemic treatment.

Figure 1

The influence of the extent of resection on local recurrence. Kaplan–Meier plot (n = 197; incomplete/complete: 74/123; p = 0.1395). Abbreviations: EOR—extent of resection, GTR—gross-total resection, STR—sub-total resection.

Figure 2

The influence of the extent of resection on OS. Kaplan–Meier plot (n = 197; incomplete/complete: 74/123; p = 0.759). Abbreviations: EOR—extent of resection, GTR—gross-total resection, STR—sub-total resection.