title: [Surgery of brain metastases].
abstract: Surgical excision of brain metastases has been well evaluated in unique metastases. Two randomized phase III trial have shown that combined with adjuvant whole brain radiotherapy, it significantly improves overall survival. However, even in the presence of multiple brain metastases, surgery may be useful. Also, even in lesions amenable to radiosurgery, surgical resection is preferred when tumors displayed cystic or necrotic aspect with important edema or when located in highly eloquent areas or cortico-subcortically. Furthermore, surgery may have a diagnostic role, in the absence of histological documentation of the primary disease, to rule out a differential diagnosis (brain abscess, lymphoma, primary tumor of the central nervous system or radionecrosis). Finally, the biological documentation of brain metastatic disease might be useful in situations where a specific targeted therapy can be proposed. Selection of patients who will really benefit from surgery should take into account three factors, clinical and functional status of the patient, systemic disease status and characteristics of intracranial metastases. Given the improved overall survival of cancer patients partially due to the advent of effective targeted therapies on systemic disease, a renewed interest has been given to the local treatment of brain metastases. Surgical resection currently represents a valuable tool in the armamentarium of brain metastases but has also become a diagnostic and decision tool that can affect therapeutic strategies in these patients.
authors: Département de neurochirurgie, CHU La Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France; Centre de recherche en oncologie et onco-pharmacologie (CRO2), faculté de médecine Timone, université Aix-Marseille, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France; Inserm U911, faculté de médecine Timone, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France. Electronic address: philippe.metellus@mail.ap-hm.fr.
authors: P
authors: P
authors: Métellus
authors: Département de neurochirurgie, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.
authors: N
authors: N
authors: Reyns
authors: Département de neurochirurgie, centre hospitalier de Colmar, 39, avenue de la Liberté, 68024 Colmar cedex, France.
authors: J
authors: J
authors: Voirin
authors: Département de neurochirurgie, hôpital Larrey, 4, rue Larrey, 49933 Angers cedex 9, France.
authors: P
authors: P
authors: Menei
authors: Département de neurochirurgie, hôpital Gui-de-Chauliac, avenue Émile-Bertin-Sans, 34000 Montpellier, France.
authors: L
authors: L
authors: Bauchet
authors: Département de neurochirurgie, CHU Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy cedex, France.
authors: T
authors: T
authors: Faillot
authors: Département de neurochirurgie, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
authors: H
authors: H
authors: Loiseau
authors: Département de neurochirurgie, hôpital Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14, France.
authors: J
authors: J
authors: Pallud
authors: Département de neurochirurgie, hôpital neurologique Wertheimer, 59, boulevard Pinel, 69677 Bron, France.
authors: J
authors: J
authors: Guyotat
authors: Département de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
authors: E
authors: E
authors: Mandonnet
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D017321:Clinical Trials, Phase I as Topic; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003399:Craniotomy; D003937:Diagnosis, Differential; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008866:Microsurgery; D019635:Neurosurgical Procedures; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Biologie des tumeurs cérébrales; Brain metastases; Chirurgie; Métastases cérébrales; Radiochirurgie; Radiosurgery; Surgery; Tumor biology