title: Surgery for brain metastases in Singapore.
abstract: The best possible treatment for a single metastasis to the brain is complete surgical excision followed by whole brain irradiation. A survey was done to determine the proportion of patients with brain metastases who had surgical excision of the lesion. The number of patients with a preoperative diagnosis of cerebral metastases who underwent surgical excision in Tan Tock Seng Hospital from 1985 to 1989 was obtained from the operation records. An average of 11 surgical excisions were done for cerebral metastases annually. To estimate the number of cases of single brain metastases seen annually in Singapore, figures of cases of cancer of the lungs, breast and colorectum from 1978 to 1982 were obtained from the Singapore Cancer Registry. Based on a conservative estimate that 20% of these cancers metastasize to the brain, that 50% are single metastasis and of these, half are suitable surgical candidates, our calculations show that there are at least 67 cases of surgically excisable single brain metastasis in Singapore annually. This means that more than 84% of patients with a single brain metastasis are not getting the best possible treatment. The reasons may be due to patients' fear of operation and to lack of awareness among physicians on advances in the management of brain metastases. Patient education and physician update on recent advances in treatment will allow patients to obtain the best possible treatment.
authors.affiliation: Department of Neurosurgery, Tan Tock Seng Hospital, Singapore.
authors.forename: W T
authors.initials: WT
authors.lastname: Seow
authors.forename: B
authors.initials: B
authors.lastname: Sadasivan
mesh_terms: D001706:Biopsy; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D012846:Singapore; D014207:Trephining