title: The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study.
abstract: BACKGROUND
  Advancements over the past generation have yielded several new treatment options for the management of brain metastases. However, surgical resection (SR) still remains the mainstay of treatment and is performed especially if decompression is required. The goal of this study was to evaluate the role of surgical resection for patients with brain metastases and to find the best indications for SR.
  
  
  METHODS
  SR as an initial treatment was performed in 157 patients. Among the 157 patients, 109 (69.4 %) and 17 (10.8 %) underwent adjuvant whole-brain radiotherapy and radiosurgery, respectively. Thirty-one (19.7 %) patients did not undergo adjuvant treatment. Overall survival, tumour recurrence, and clinical outcomes were evaluated. The clinical situation was classified based on the recursive partitioning analysis (RPA) class and Karnofsky performance scale (KPS).
  
  
  RESULTS
  The overall median survival was 19.3 months. Median survival according to the extent of surgical resection was 20.4 months after gross total resection (GTR) and 15.1 months after subtotal resection (STR) (P = 0.016). The patients with stable primary extracranial cancer survived longer than patients with synchronous detection of extracranial cancer (P = 0.032). The RPA I class patients showed longer survival than the RPA II class patients (P = 0.047). This difference was more prominent in the GTR group than in the STR group (GTR, P = 0.022; STR, P = 0.075). The KPS score of the GTR group changed from 82.3 to 87.0 and that of the STR group changed from 79.2 to 77.1 (P = 0.001). Adjuvant treatment did not lead to a significant improvement in the survival and clinical outcome.
  
  
  CONCLUSIONS
  Surgical resection may accomplish satisfactory outcomes with technical advancement. The best indications for SR for brain metastasis are RPA I class, stable extracranial cancer, and a planned GTR of the tumour. Even with the advancements in adjuvant therapy, surgical resection plays a major role in the management of brain metastasis.
authors: Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors: Chang-Hyun
authors: CH
authors: Lee
authors: Dong Gyu
authors: DG
authors: Kim
authors: Jin Wook
authors: JW
authors: Kim
authors: Jung Ho
authors: JH
authors: Han
authors: Yong Hwy
authors: YH
authors: Kim
authors: Chul-Kee
authors: CK
authors: Park
authors: Chae-Yong
authors: CY
authors: Kim
authors: Sun Ha
authors: SH
authors: Paek
authors: Hee-Won
authors: HW
authors: Jung
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D056910:Republic of Korea; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome