J Korean Med Sci.  2009 Aug;24(4):641-648. 10.3346/jkms.2009.24.4.641.

Clinical Analysis of Patients who Survived for Less than 3 Months After Brain Metastatectomy

• Kim YZ
• Kim KH
• Kim JS
• Song YJ
• Kim KU
• Kim HD

• KMID: 1779197
• DOI: http://doi.org/10.3346/jkms.2009.24.4.641

Abstract

In the patients with brain metastasis (BM), it is impossible to determine who will benefit from surgery because of limited survival. In an attempt to identify optimal candidates for brain metastatectomy, we analyzed patients who survived for <3 months after craniotomy for a single BM lesion. Between January 1st, 1997 and July 31st, 2007, 83 patients with a single BM underwent craniotomy. Of these patients, 25 patients (30.1%) died within 3 months of craniotomy. The primary lesions were non-small call lung cancer in 15, colon cancer in 6, and breast cancer, renal cell carcinoma, ovarian cancer, or esophageal cancer in one apiece. Of the 25 patients, 19 (79%) were of tumor stage IV and had extra-cranial metastasis. Eleven (44%) of the 25 primary cancers had a well-controlled status. Twelve patients (48%) had a Karnofsky Performance Scale (KPS) score of <70, and 13 (52%) were of Recursive Partitioning Analysis (RPA) class 3. Primary cancer status, RPA class, and functional status were found to be critical factors for consideration when selecting surgical candidates. In addition, adjuvant therapy was found to have an important role on survival.

Keyword

Brain Metastasis; Metastatectomy; Prognosis; Surgical Candidate; Survival

MeSH Terms

Adult
Aged
Brain Neoplasms/mortality/*secondary/*surgery
Craniotomy
Data Interpretation, Statistical
Female
Humans
Male
Middle Aged
Neoplasm Staging
Survival Analysis

Figure

• 

  Fig. 1 Survival and time-intervals during clinical course of patients who survived less than 3 months after brain metastatectomy.

Reference

1. Johnson JD, Young B. Demographics of brain metastasis. Neurosurg Clin N Am. 1996. 7:337–344.

2. Posner JB. Management of brain metastases. Rev Neurol (Paris). 1992. 148:477–487.

3. Wronski M, Arbit E, Burt M, Galicich JH. Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991. J Neurosurg. 1995. 83:605–616.

4. Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol. 1978. 19:579–592.

5. Lang Frederick F, Chang Eric L, Abis-Said Dima, Wildrick David M, Sawaya R. Youmans JR, editor. Metastatic brain tumors. Neurological Surgery. 2003. Vol 1:ed 5. Philadelphia: WB Saunders;1077–1097.

6. Central Nervous System Cancer. Version 1. NCCN Clinical Practice Guideline in Oncology. accessed Feb 27, 2008. Available at http://www.nccn.org/professionals/physician_gls/PDF/cns.pdf.

7. Karnofsky D, Abelmann W, Craver L. The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer. 1948. 1:634–656.

8. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997. 37:745–751.

9. Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM. Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery. 1998. 42:1044–1056.

10. Penel N, Brichet A, Prevost B, Duhamel A, Assaker R, Dubois F, Lafitte JJ. Prognostic factors of synchronous brain metastases from lung cancer. Lung Cancer. 2001. 33:143–154.

11. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, Macdonald JS, Young B. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990. 322:494–500.

12. Hankins JR, Miller JE, Salcman M, Ferraro F, Green DC, Attar S, McLaughlin JS. Surgical management of lung cancer with solitary cerebral metastasis. Ann Thorac Surg. 1988. 46:24–28.

13. Magilligan DJ Jr, Duvernoy C, Malik G, Lewis JW Jr, Knighton R, Ausman JI. Surgical approach to lung cancer with solitary cerebral metastasis: twenty-five years' experience. Ann Thorac Surg. 1986. 42:360–364.

14. Mussi A, Pistolesi M, Lucchi M, Janni A, Chella A, Parenti G, Rossi G, Angeletti CA. Resection of single brain metastasis in non-small cell lung cancer: prognostic factors. J Thorac Cardiovasc Surg. 1996. 112:146–153.

15. Rossi NP, Zavala DC, VanGilder JC. A combined surgical approach to non-oat-cell pulmonary carcinoma with single cerebral metastasis. Respiration. 1987. 51:170–178.

16. Billing PS, Miller DL, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Surgical treatment of primary lung cancer with synchronous brain metastases. J Thorac Cardiovasc Surg. 2001. 122:548–553.

17. Sills AK. Current treatment approaches to surgery for brain metastases. Neurosurgery. 2005. 57(5):Suppl. S24–S32.

18. Gerosa M, Nicolato A, Severi F, Ferraresi P, Masotto B, Barone G, Foroni R, Piovan E, Pasoli A, Bricolo A. Gamma knife radiosurgery for intracranial metastases: from local tumor control to increased survival. Stereotact Funct Neurosurg. 1996. 66:Suppl 1. 184–192.

19. Hasegawa T, Kondziolka D, Flickinger JC, Germanwala A, Lunsford LD. Brain metastases treated with radiosurgery alone: An alternative to whole brain radiotherapy? Neurosurgery. 2003. 52:1318–1326.

20. Lutterbach J, Cyron D, Henne K, Ostertag CB. Radiosurgery followed by planned observation in patients with one to three brain metastases. Neurosurgery. 2003. 52:1066–1074.

21. Muacevic A, Kreth FW, Tonn JC, Wowra B. Stereotactic radiosurgery for multiple brain metastases from breast carcinoma. Cancer. 2004. 100:1705–1711.

22. Macchiarini P, Buonaguidi R, Hardin M, Mussi A, Angeletti CA. Results and prognostic factors of surgery in the management of non-small cell lung cancer with solitary brain metastasis. Cancer. 1991. 68:300–304.

23. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B. Postoperative radiotherapy in the treatment of single metastases to the brain; a randomized trial. JAMA. 1998. 280:1485–1489.

24. Lang FF, Sawaya R. Surgical treatment of metastatic brain tumors. Semin Surg Oncol. 1998. 14:53–63.

25. Postmus PE, Smit EF. Chemotherapy for brain metastases of lung cancer; a review. Ann Oncol. 1999. 10:753–759.

26. Soffietti R, Costanza A, Laguzzi E, Nobile M, Ruda R. Radiotherapy and chemotherapy of brain metastases. J Neurooncol. 2005. 75:31–42.

27. van den Bent MJ. The role of chemotherapy in brain metastases. Eur J Cancer. 2003. 39:2114–2120.

28. Schuette W. Treatment of brain metastases from lung cancer; Chemotherapy. Lung Cancer. 2004. 45:Suppl 2. S253–S257.