title: Surgery of recurrent brain metastases: retrospective analysis of 67 patients.
abstract: OBJECTIVE
  Treatment of patients with recurrent brain metastasis is one of the major challenges in neurooncology. Commonly, WBRT was applied after or as the initial treatment. Many patients received radiosurgery or their lesions were operated on. The question arises of what treatment modalities are appropriate and can be offered to the patients. In our retrospective analysis, we evaluated whether re-operation might be a useful measurement for the patients with respect to overall survival and quality of life.
  
  
  METHODS
  We included 67 patients who were treated between 1993 and 2008 in our department. The median age was 59 years. Metastases of 11 different primaries were diagnosed. The median OST was 7.5 months.
  
  
  RESULTS
  Statistically significant prognostic factors for OS were single lesions, completeness of resection, and time to recurrence, which was significantly influenced by WBRT after first operation. The one year survival rate correlated with the RPA classification: class I: 53.3 %, class II: 26.9 %, class III: 12.5 %. In 31.3 %, a second recurrence occurred which was treated by repeated surgery. Six patients survived as long-term survivors (25.7-132.2 months).
  
  
  CONCLUSIONS
  Surgery of recurrent brain metastasis is an important therapeutic option. A subgroup of patients, defined by prognostic factors, will profit with improvement of symptoms and prolongation of the overall survival time. Even long-term survivors can be expected.
authors.affiliation: Department of Neurosurgery, Technical University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany, Gabriele.Schackert@uniklinikum-dresden.de.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.forename: Konrad
authors.initials: K
authors.lastname: Schmiedel
authors.forename: Claudia
authors.initials: C
authors.lastname: Lindner
authors.forename: Mario
authors.initials: M
authors.lastname: Leimert
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D055502:Secondary Prevention; D015996:Survival Rate