title: Significance of surgical resection for the treatment of multiple brain metastases.
abstract: BACKGROUND
  We investigated the role of surgery in the treatment of multiple brain metastases when performed with radiation therapy.
  
  
  METHODS
  One hundred and thirty-eight patients who underwent resection for brain metastases and received 30 Gy or more of adjuvant radiation therapy were entered into this study. Seventy-seven of the 138 patients (56%) had single brain metastases (Single Group), while the remaining 61 patients (44%) had multiple foci (Multiple Group). The 138 patients were divided into four subgroups; patients in Single Group treated with total or subtotal resection (Group A), those in Multiple Group who underwent total or subtotal resection and had remaining tumors smaller than 2 cm (Group B), those in Single Group treated with partial resection (Group C), and the other patients in Multiple Group (Group D).
  
  
  RESULTS
  The median survival was 8.7 and 9.2 months for the Single Group and the Multiple Group, respectively (not statistically different). The median survival was 9.6, 12.4, 3.7, and 4.5 months for Groups A, B, C, and D, respectively. Survival duration differed significantly between Groups A/B and Groups C/D (p < 0.05).
  
  
  CONCLUSIONS
  Surgical reduction of tumor volume which is approximately larger than 2 cm improves the efficacy of adjuvant radiation therapy and contributes to survival even in the patients with multiple brain metastases.
authors.affiliation: Department of Neurosurgery, Chiba University, School of Medicine, Japan. iwadate@med.m.chiba-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Iwadate
authors.forename: H
authors.initials: H
authors.lastname: Namba
authors.forename: A
authors.initials: A
authors.lastname: Yamaura
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D002277:Carcinoma / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome